Smartphone as a remote touchpad to facilitate visualization of 3D cerebral angiograms during aneurysm surgery

Background: During aneurysm surgery, neurosurgeons may need to look at the cerebral angiograms again to better orient themselves to the aneurysm and also the surrounding vascular anatomy. Simplification of the intraoperative imaging review and reduction of the time interval between the view under the microscope and the angiogram review can theoretically improve orientation. 

Objective: To describe the use of a smartphone as a remote touchpad to simplify intraoperative visualization of three-dimensional (3D) cerebral angiograms and reduce the time interval between the view under the microscope and the angiogram review. 

Methods: Anonymized 3D angiograms of the patients in Virtual Reality Modelling Language format are securely uploaded to sketchfab.com, accessible through smartphone Web browsers. A simple software has been developed and made available to facilitate the workflow. The smartphone is connected wirelessly to an external monitor using a Chromecast device and is used intraoperatively as a remote touchpad to view/rotate/zoom the 3D aneurysms angiograms on the external monitor. 

Results: Implementation of the method is practical and helpful for the surgeon in certain cases. It also helps the operating staff, registrars, and students to orient themselves to the surgical anatomy. I present 10 of the uploaded angiograms published online. 

Conclusion: The concept and method of using the smartphone as a remote touchpad to improve intraoperative visualization of 3D cerebral angiograms is described. The implementation is practical, using easily available hardware and software, in most neurosurgical centers worldwide. The method and concept have potential for further development.