Application of Extended Reality (XR)-Assisted Computed Tomography (CT)-Guided Localization in Extracranial-intracranial (EC-IC) Bypass Surgery

July 21, 2026 updated by: National Taiwan University Hospital

Application of Extended Reality (XR)-Assisted CT-Guided Localization in Extracranial-intracranial (EC-IC) Bypass Surgery

This study will evaluate the application of a metaverse-based surgical simulation platform in extracranial-intracranial (EC-IC) bypass surgery. The study population will include patients with moyamoya disease or chronic cerebral ischemia who are scheduled to undergo EC-IC bypass surgery.

Before surgery, preoperative brain computed tomography images will be imported into the metaverse surgical simulation platform. During surgery, extended reality technology will be used to provide precise localization of the relevant vessels, including both the donor and recipient arteries.

The primary objective is to assess the localization accuracy of this platform. The study will also investigate whether this technology can facilitate a minimally invasive surgical approach and improve surgical safety.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Device: NTU OpVerse surgical simulation platform

Study Type

Observational

Enrollment (Estimated)

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Name: Chiu Hao Hsu
Phone Number: 73234 88623123456
Email: newmanhsu0814@gmail.com

Study Locations

Taiwan
- - Taipei, Taiwan
    - Recruiting
    - National Taiwan University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

Adult
Older Adult

Accepts Healthy Volunteers

Sampling Method

Non-Probability Sample

Study Population

The study population will include adult patients diagnosed with ischemic moyamoya disease, moyamoya syndrome, or chronic intracranial internal carotid artery stenosis or occlusion who are scheduled to undergo extracranial-intracranial bypass surgery. Eligible procedures include STA-MCA bypass, STA trunk-graft-MCA bypass, and other cerebral revascularization procedures using the superficial temporal artery or another branch of the external carotid artery as the donor vessel. Patients requiring emergency surgery, those with contraindications to CT imaging, severe systemic illness precluding follow-up assessment, scalp conditions or anatomical deformities preventing surface registration, or unreliable XR registration that may compromise surgical safety will be excluded.

Description

Inclusion Criteria:

Adult patients diagnosed with ischemic moyamoya disease, moyamoya syndrome, or chronic intracranial internal carotid artery stenosis or occlusion (chronic ICA stenosis/occlusion).
Patients scheduled to undergo extracranial-intracranial bypass surgery (EC-IC bypass), including superficial temporal artery-middle cerebral artery bypass (STA-MCA bypass), superficial temporal artery trunk-interposition graft-middle cerebral artery bypass (STA trunk-graft-MCA bypass), or other cerebral revascularization procedures using the superficial temporal artery or another branch of the external carotid artery system (STA/ECA system) as the donor blood supply.

Exclusion Criteria:

Presence of a contraindication to computed tomography (CT) scanning.
Presence of a severe systemic illness that would prevent participation in subsequent study assessments, such as poorly controlled diabetes mellitus, active malignancy, or severe cardiac disease.
The need for emergency surgery without sufficient time to complete image-based modeling and registration.
Presence of scalp lesions, wounds, or anatomical deformities that prevent reliable surface registration.
The XR registration result is considered unreliable by the research team and may potentially compromise surgical safety.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Accuracy of XR-Assisted Superficial Temporal Artery Localization Time Frame: During preoperative surgical planning and intraoperative confirmation on the day of surgery.	Accuracy will be assessed as the absolute distance, measured in millimeters, between the superficial temporal artery location marked using the XR-assisted surgical planning system and the actual superficial temporal artery location identified by vascular ultrasonography. The mean absolute distance error across participants will be reported.	During preoperative surgical planning and intraoperative confirmation on the day of surgery.
Accuracy of XR-Assisted Middle Cerebral Artery Recipient-Vessel Prediction Time Frame: From preoperative surgical planning to intraoperative selection of the recipient vessel on the day of surgery.	Accuracy will be assessed as the absolute distance, measured in millimeters, between the anastomosis site predicted using the XR-assisted surgical planning system and the actual recipient-vessel anastomosis site selected intraoperatively. The mean absolute distance error across participants will be reported.	From preoperative surgical planning to intraoperative selection of the recipient vessel on the day of surgery.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
XR-Assisted STA Localization Time Time Frame: During preoperative preparation on the day of surgery.	The time required to localize and mark the superficial temporal artery and middle cerebral artery using the XR-assisted system will be measured in minutes, from initiation of XR registration and localization to completion of skin marking.	During preoperative preparation on the day of surgery.
Time From Skin Incision to Identification of the Recipient Vessel Time Frame: During the surgical procedure on the day of surgery.	The time from the initial skin incision to intraoperative identification of the middle cerebral artery recipient vessel selected for bypass will be measured in minutes.	During the surgical procedure on the day of surgery.
Total Operative Time Time Frame: During the surgical procedure on the day of surgery.	Total operative time will be measured in minutes, from the initial skin incision to completion of skin closure.	During the surgical procedure on the day of surgery.
Skin-Incision Length Time Frame: At completion of skin closure on the day of surgery.	The length of the final skin incision will be measured in centimeters after completion of the surgical procedure.	At completion of skin closure on the day of surgery.
Maximum Craniotomy Diameter Time Frame: During the surgical procedure on the day of surgery.	The maximum diameter of the completed craniotomy will be measured in centimeters intraoperatively.	During the surgical procedure on the day of surgery.
Intraoperative Enlargement of the Planned Craniotomy Time Frame: During the surgical procedure on the day of surgery.	The number and percentage of participants requiring intraoperative enlargement of the craniotomy beyond the preoperatively planned dimensions will be reported.	During the surgical procedure on the day of surgery.
Intraoperative Bypass Blood Flow Time Frame: Immediately after completion of the bypass anastomosis on the day of surgery.	Blood flow through the completed bypass will be measured in milliliters per minute using an intraoperative flow-measurement device after completion of the anastomosis.	Immediately after completion of the bypass anastomosis on the day of surgery.
Postoperative Ischemic Complications Time Frame: From completion of surgery through 30 days after surgery.	The number and percentage of participants experiencing a new postoperative cerebral ischemic event, including transient ischemic attack or ischemic stroke, will be reported. Events will be determined by neurological assessment and clinically indicated neuroimaging.	From completion of surgery through 30 days after surgery.
Postoperative Hemorrhagic Complications Time Frame: From completion of surgery through 30 days after surgery.	The number and percentage of participants experiencing a new postoperative intracranial hemorrhagic complication will be reported. Events will be determined by neurological assessment and postoperative neuroimaging	From completion of surgery through 30 days after surgery.
Change in Modified Rankin Scale Score Time Frame: From baseline before surgery to 30 days after surgery.	The change in modified Rankin Scale score will be calculated as the postoperative score minus the preoperative baseline score. The modified Rankin Scale ranges from 0 to 6, with higher scores indicating greater disability.	From baseline before surgery to 30 days after surgery.
Length of Intensive Care Unit Stay Time Frame: From completion of surgery through discharge from the intensive care unit, up to 30 days after surgery.	The duration of postoperative intensive care unit stay will be measured in days, from admission to the intensive care unit after surgery to transfer out of the intensive care unit.	From completion of surgery through discharge from the intensive care unit, up to 30 days after surgery.
Total Length of Hospital Stay Time Frame: From the date of surgery through hospital discharge, up to 30 days after surgery.	The total postoperative hospital stay will be measured in days, from the date of surgery to the date of hospital discharge.	From the date of surgery through hospital discharge, up to 30 days after surgery.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

National Taiwan University Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 26, 2026

Primary Completion (Estimated)

December 31, 2028

Study Completion (Estimated)

December 31, 2028

Study Registration Dates

First Submitted

July 14, 2026

First Submitted That Met QC Criteria