A Survey of auditory display in image-guided interventions <s> Clinical evaluations <s> In this study the authors measured the effect of auditory feedback during image-guided surgery (IGS) in a phantom model and in a clinical setting. In the phantom setup, advanced IGS with complementary auditory feedback was compared with results obtained with 2 routine forms of IGS, either with an on-screen image display or with image injection via a microscope. The effect was measured by means of volumetric resection assessments. The authors also present their first clinical data concerning the effects of complementary auditory feedback on instrument handling during image-guided neurosurgery. When using image-injection through the microscope for navigation, however, resection quality was significantly worse. In the clinical portion of the study, the authors performed resections of cerebral mass lesions in 6 patients with the aid of auditory feedback. Instrument tip speeds were slightly (although significantly) influenced by this feedback during resection. Overall, the participating neurosurgeons reported that the auditory feedback helped in decision-making during resection without negatively influencing instrument use. Postoperative volumetric imaging studies revealed resection rates of > or = 95% when IGS with auditory feedback was used. There was only a minor amount of brain shift, and postoperative resection volumes corresponded well with the preoperative intentions of the neurosurgeon. Although the results of phantom surgery with auditory feedback revealed no significant effect on resection quality or extent, auditory cues may help prevent damage to eloquent brain structures. <s> BIB001 </s> A Survey of auditory display in image-guided interventions <s> Clinical evaluations <s> Purpose We developed a surgical navigation system that warns the surgeon with auditory and visual feedback to protect the facial nerve with real-time monitoring of the safe region during drilling. <s> BIB002 </s> A Survey of auditory display in image-guided interventions <s> Clinical evaluations <s> In cochlear implantation (CI), the insertion of the electrode array into the appropriate compartment of the cochlea, the scala tympani, is important for an optimal hearing outcome. The current surgical technique for CI depends primarily on the surgeon's skills and experience level to achieve the correct placement of the electrode array, and the surgeon needs to confirm that the exact placement is achieved prior to completing the procedure. Thus, a surgical navigation system can help the surgeon to access the scala tympani without injuring important organs in the complex structure of the temporal bone. However, the use of a surgical microscope has restricted the effectiveness of the surgical navigation because it has been difficult to deliver the navigational information to the surgeon from outside of the surgeon's visual attention. We herein present a clinical feasibility study of an auditory feedback function developed as a computer-surgeon interface that can guide the surgeon to the preset cochleostomy location. As a result, the surgeon could confirm that the drilling point was correct, while keeping his or her eyes focused on the microscope. The proposed interface reduced the common frustration that surgeons experience when using surgical navigation during otologic surgeries. <s> BIB003
Four of the 15 reviewed articles evaluated their approaches in clinical conditions in addition to the laboratory studies described in "Laboratory evaluations" section; see Table 4 . Woerdeman et al. BIB001 report 6 patient neurosurgical resections during which auditory display was switched on and off at random intervals by the primary investigator. Instrument tip movement was measured, including mean tip translational speed and mean tip rotational speed. A specific effect on instrument tip speed could not be determined. Surgeons subjectively reported improvements in decision-making when using the auditory display without negatively influencing instrument use. Strauss et al.  measured complication rate during functional endoscopic sinus surgery with 4 surgeons and 104 patients. A combined audiovisual collision-warning system was compared to conventional navigation display. The complication rate for critical incidents using conventional navigation and the collision-warning system was 11.3 and 7%, respectively, and 3.9 and 2.12% for small complications, respectively. The time to prepare the navigation system rose when using the collision-warning system. Cho et al. BIB002 report one experienced surgeon who performed 2 cochlear implantations and 1 acoustic tumor resection using auditory display with 3 warning margins. Although no statistics were gathered, findings indicate that the auditory display made it possible for the surgeon to continuously concentrate on the operating situs without having to switch the view to the screen. In a second study in 2014, Cho et al. BIB003 report that, during surgeries on 2 patients, the auditory display helped the surgeon find the correct cochleostomy spot while maintaining focus on the microscope.