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Ahmadi P, Kazemi MA, Yazdani N, Dabiri S. Determination of the radioanatomical factors related to the position of facial nerve in accessing jugular foramen and carotid artery in temporal bone. Heliyon 2024; 10:e26560. [PMID: 38404895 PMCID: PMC10884483 DOI: 10.1016/j.heliyon.2024.e26560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Preservation of the facial nerve is of great importance in temporal bone surgeries. We intend to investigate the measurements of the radioanatomical factors related to the position of the facial nerve in accessing jugular foramen and internal carotid artery (ICA) in temporal bone of patients who were candidates for temporal high resolution computed tomography (HRCT) scan. Methods In this correlation cross-sectional study, samples were selected from patients referred to Amir Alam Hospital who were previously candidates for temporal HRCT. Radioanatomic factors were evaluated in three axial, coronal and sagittal views. Analyzes were performed using descriptive statistics, correlation analysis and factor analysis. Results A total of 173 samples were investigated. The most reliable radioanatomical factor based on coefficient of variation (CV) was the distance of the 7th nerve to the temporomandibular joint (TMJ) in the inferior to the cochlea in the sagittal view (variable name S2) (CV = 8.1%) and then the distance from the 7th nerve to the TMJ in the inferior section of the cochlea in the axial view (variable name AI3) (CV = 8.4%). Based on correlation analysis and then confirmatory factor analysis, three common latent factors were identified (overall R2 = 0.999). Conclusion The results of this study can be used for two purposes. First, the direct use of the estimated measures in surgical operations, and the second is more advanced modeling to choose the approach in the surgical operation and how to implement that approach. For the first aim, the two factors AI3 and S2 were the most reliable radioanatomical factors in different people. For the second aim, the three-dimensional understanding of the obtained measurements and the further identification of the anatomical nature of the latent factors can help in choosing the approach in surgery.
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Affiliation(s)
- Parisadat Ahmadi
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Kazemi
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Complex Hospital, Tehran, Iran
| | - Nasrin Yazdani
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Dabiri
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Schneider D, Anschuetz L, Mueller F, Hermann J, O'Toole Bom Braga G, Wagner F, Weder S, Mantokoudis G, Weber S, Caversaccio M. Freehand Stereotactic Image-Guidance Tailored to Neurotologic Surgery. Front Surg 2021; 8:742112. [PMID: 34692764 PMCID: PMC8529212 DOI: 10.3389/fsurg.2021.742112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
Hypothesis: The use of freehand stereotactic image-guidance with a target registration error (TRE) of μTRE + 3σTRE < 0.5 mm for navigating surgical instruments during neurotologic surgery is safe and useful. Background: Neurotologic microsurgery requires work at the limits of human visual and tactile capabilities. Anatomy localization comes at the expense of invasiveness caused by exposing structures and using them as orientation landmarks. In the absence of more-precise and less-invasive anatomy localization alternatives, surgery poses considerable risks of iatrogenic injury and sub-optimal treatment. There exists an unmet clinical need for an accurate, precise, and minimally-invasive means for anatomy localization and instrument navigation during neurotologic surgery. Freehand stereotactic image-guidance constitutes a solution to this. While the technology is routinely used in medical fields such as neurosurgery and rhinology, to date, it is not used for neurotologic surgery due to insufficient accuracy of clinically available systems. Materials and Methods: A freehand stereotactic image-guidance system tailored to the needs of neurotologic surgery-most importantly sub-half-millimeter accuracy-was developed. Its TRE was assessed preclinically using a task-specific phantom. A pilot clinical trial targeting N = 20 study participants was conducted (ClinicalTrials.gov ID: NCT03852329) to validate the accuracy and usefulness of the developed system. Clinically, objective assessment of the TRE is impossible because establishing a sufficiently accurate ground-truth is impossible. A method was used to validate accuracy and usefulness based on intersubjectivity assessment of surgeon ratings of corresponding image-pairs from the microscope/endoscope and the image-guidance system. Results: During the preclinical accuracy assessment the TRE was measured as 0.120 ± 0.05 mm (max: 0.27 mm, μTRE + 3σTRE = 0.27 mm, N = 310). Due to the COVID-19 pandemic, the study was terminated early after N = 3 participants. During an endoscopic cholesteatoma removal, a microscopic facial nerve schwannoma removal, and a microscopic revision cochlear implantation, N = 75 accuracy and usefulness ratings were collected from five surgeons each grading 15 image-pairs. On a scale from 1 (worst rating) to 5 (best rating), the median (interquartile range) accuracy and usefulness ratings were assessed as 5 (4-5) and 4 (4-5) respectively. Conclusion: Navigating surgery in the tympanomastoid compartment and potentially in the lateral skull base with sufficiently accurate freehand stereotactic image-guidance (μTRE + 3σTRE < 0.5 mm) is feasible, safe, and useful. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03852329.
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Affiliation(s)
- Daniel Schneider
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Fabian Mueller
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Jan Hermann
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | | | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Stefan Weder
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
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Rothweiler R, Metzger MC, Voss PJ, Beck J, Schmelzeisen R. Interdisciplinary management of skull base surgery. J Oral Biol Craniofac Res 2021; 11:601-607. [PMID: 34567964 DOI: 10.1016/j.jobcr.2021.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022] Open
Abstract
Skull base surgery remains one of the challenging areas in the field of cranio-maxillofacial surgery, otolaryngology and neurosurgery. Subsequent reconstruction of bone and soft tissue are an essential component to restore function and appearance after ablative surgery. Establishment of interdisciplinary tumor boards with presentation of the individual patient cases have become standard. Multiplanar reconstruction using MRI or CT imaging techniques combined with virtual 3D planning allow precise planning of the procedures. Intraoperative navigation helps for complete resection of malignant findings with safety margins; surgical approaches provide a good overview of the surgical site. Reconstruction using local flaps have a low complication rate with equally reliable results in reconstruction of small tissue defects. Free flap surgery makes reconstruction of large tissue defects possible. Alloplastic materials are alternatively used for reconstruction of bone defects. Based on selected patients, treatment algorithms and standard surgical procedures in extracerebral skull base surgery will be illustrated. Current techniques and new approaches will be discussed with emphasize on hard and soft tissue reconstruction.
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Affiliation(s)
- R Rothweiler
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M C Metzger
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - P J Voss
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Beck
- Department of Neurosurgery, Faculty of Medicine, University of Freiburg, Freiburg, 79106 Germany
| | - R Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Schneider D, Hermann J, Mueller F, Braga GOB, Anschuetz L, Caversaccio M, Nolte L, Weber S, Klenzner T. Evolution and Stagnation of Image Guidance for Surgery in the Lateral Skull: A Systematic Review 1989-2020. Front Surg 2021; 7:604362. [PMID: 33505986 PMCID: PMC7831154 DOI: 10.3389/fsurg.2020.604362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/13/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Despite three decades of pre-clinical and clinical research into image guidance solutions as a more accurate and less invasive alternative for instrument and anatomy localization, translation into routine clinical practice for surgery in the lateral skull has not yet happened. The aim of this review is to identify challenges that need to be solved in order to provide image guidance solutions that are safe and beneficial for use during lateral skull surgery and to synthesize factors that facilitate the development of such solutions. Methods: Literature search was conducted via PubMed using terms relating to image guidance and the lateral skull. Data extraction included the following variables: image guidance error, imaging resolution, image guidance system, tracking technology, registration method, study endpoints, clinical target application, and publication year. A subsequent search of FDA 510(k) database for identified image guidance systems and extraction of the year of approval, intended use, and indications for use was performed. The study objectives and endpoints were subdivided in three time phases and summarized. Furthermore, it was analyzed which factors correlated with the image guidance error. Factor values for which an error ≤0.5 mm (μerror + 3σerror) was measured in more than one study were identified and inspected for time trends. Results: A descriptive statistics-based summary of study objectives and findings separated in three time intervals is provided. The literature provides qualitative and quantitative evidence that image guidance systems must provide an accuracy ≤0.5 mm (μerror + 3σerror) for their safe and beneficial application during surgery in the lateral skull. Spatial tracking accuracy and precision and medical image resolution both correlate with the image guidance accuracy, and all of them improved over the years. Tracking technology with accuracy ≤0.05 mm, computed tomography imaging with slice thickness ≤0.2 mm, and registration based on bone-anchored titanium fiducials are components that provide a sufficient setting for the development of sufficiently accurate image guidance. Conclusion: Image guidance systems must reliably provide an accuracy ≤0.5 mm (μerror + 3σerror) for their safe and beneficial use during surgery in the lateral skull. Advances in tracking and imaging technology contribute to the improvement of accuracy, eventually enabling the development and wide-scale adoption of image guidance solutions that can be used safely and beneficially during lateral skull surgery.
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Affiliation(s)
- Daniel Schneider
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Jan Hermann
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Fabian Mueller
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | | | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Lutz Nolte
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Thomas Klenzner
- Department of Otorhinolaryngology, University Hospital Düsseldorf, Düsseldorf, Germany
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5
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Weber S, Gavaghan K, Wimmer W, Williamson T, Gerber N, Anso J, Bell B, Feldmann A, Rathgeb C, Matulic M, Stebinger M, Schneider D, Mantokoudis G, Scheidegger O, Wagner F, Kompis M, Caversaccio M. Instrument flight to the inner ear. Sci Robot 2021; 2. [PMID: 30246168 DOI: 10.1126/scirobotics.aal4916] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Surgical robot systems can work beyond the limits of human perception, dexterity and scale making them inherently suitable for use in microsurgical procedures. However, despite extensive research, image-guided robotics applications for microsurgery have seen limited introduction into clinical care to date. Among others, challenges are geometric scale and haptic resolution at which the surgeon cannot sufficiently control a device outside the range of human faculties. Mechanisms are required to ascertain redundant control on process variables that ensure safety of the device, much like instrument-flight in avionics. Cochlear implantation surgery is a microsurgical procedure, in which specific tasks are at sub-millimetric scale and exceed reliable visuo-tactile feedback. Cochlear implantation is subject to intra- and inter-operative variations, leading to potentially inconsistent clinical and audiological outcomes for patients. The concept of robotic cochlear implantation aims to increase consistency of surgical outcomes such as preservation of residual hearing and reduce invasiveness of the procedure. We report successful image-guided, robotic CI in human. The robotic treatment model encompasses: computer-assisted surgery planning, precision stereotactic image-guidance, in-situ assessment of tissue properties and multipolar neuromonitoring (NM), all based on in vitro, in vivo and pilot data. The model is expandable to integrate additional robotic functionalities such as cochlear access and electrode insertion. Our results demonstrate the feasibility and possibilities of using robotic technology for microsurgery on the lateral skull base. It has the potential for benefit in other microsurgical domains for which there is no task-oriented, robotic technology available at present.
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Affiliation(s)
- S Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - K Gavaghan
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - W Wimmer
- ARTORG Center for Biomedical Engineering Research, University of Bern.,Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital
| | - T Williamson
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - N Gerber
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - J Anso
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - B Bell
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - A Feldmann
- Institute for Surgical Technologies and Biomechanics, University of Bern
| | - C Rathgeb
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - M Matulic
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - M Stebinger
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - D Schneider
- ARTORG Center for Biomedical Engineering Research, University of Bern
| | - G Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital
| | - O Scheidegger
- Department Neurology, Inselspital, Bern University Hospital
| | - F Wagner
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital
| | - M Kompis
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital
| | - M Caversaccio
- ARTORG Center for Biomedical Engineering Research, University of Bern.,Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital
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Schwam ZG, Kaul VZ, Cosetti MK, Wanna GB. The utility of intraoperative navigation of the temporal bone for otolaryngology resident training. Laryngoscope 2019; 130:E368-E371. [DOI: 10.1002/lary.28219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Zachary G. Schwam
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount SinaiMount Sinai Health System New York New York U.S.A
- the Department of Otolaryngology, New York Eye and Ear Infirmary of Mount SinaiMount Sinai Health System New York New York U.S.A
| | - Vivian Z. Kaul
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount SinaiMount Sinai Health System New York New York U.S.A
- the Department of Otolaryngology, New York Eye and Ear Infirmary of Mount SinaiMount Sinai Health System New York New York U.S.A
| | - Maura K. Cosetti
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount SinaiMount Sinai Health System New York New York U.S.A
- the Department of Otolaryngology, New York Eye and Ear Infirmary of Mount SinaiMount Sinai Health System New York New York U.S.A
- the Audiology, Hearing, and Balance CenterMount Sinai Health System New York New York U.S.A
- Ear InstituteMount Sinai Health System New York New York U.S.A
| | - George B. Wanna
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount SinaiMount Sinai Health System New York New York U.S.A
- the Department of Otolaryngology, New York Eye and Ear Infirmary of Mount SinaiMount Sinai Health System New York New York U.S.A
- the Audiology, Hearing, and Balance CenterMount Sinai Health System New York New York U.S.A
- Ear InstituteMount Sinai Health System New York New York U.S.A
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7
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Accuracy Assessment of Different Registration and Imaging Methods on Image-Guided Surgery of Lateral Skull Base. ARCHIVES OF NEUROSCIENCE 2018. [DOI: 10.5812/ans.74051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Image-guided implantation of the Bonebridge™ with a surgical navigation: A feasibility study. Int J Surg Case Rep 2016; 30:112-117. [PMID: 28012324 PMCID: PMC5192035 DOI: 10.1016/j.ijscr.2016.11.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/28/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To access a method of fitting a designated location on the patient's temporal bone by surgically navigating to the Bonebridge implantation. STUDY DESIGN A patient with unilateral profound hearing loss received early intervention with the Bonebridge implant for binaural hearing. The optimal implant site was determined from computed tomography (CT) images using a three-dimensional (3D) simulation software program before the surgery. The pre-calculated coordinates from the 3D simulation software program were moved to the Scopis Hybrid Navigation System. After using the surgical navigation system for the surgery, we evaluated the degree of mismatch of the center of the bone conduction-floating mass transducer (BC-FMT) between the computer simulation and the actual drilling. RESULTS The time required to determine the implant location on the surface of the patient's temporal bone was shortened, and the accuracy of the implantation was high. The coordinates on the 3D simulation system were comparable to the surgical navigation system. The predicted coordinates were replicated exactly upon actual drilling during the surgery, and we could confirm this in preoperative and postoperative images. CONCLUSIONS Using an image-guided surgical navigation system to aid in the placement of the BC-FMT on the simulated location is a simple procedure and is more effective that finding the exact coordinates. It also shortens the decision time for applying the implant.
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Ke J, Zhang S, Li C, Zhu Y, Hu L, Ma F. Application of bonebed-malleus short process registration in minimally invasive cochlear implantation. Comput Assist Surg (Abingdon) 2016. [DOI: 10.1080/24699322.2016.1240306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Jia Ke
- Department of Otorhinolarygology Head and Neck Surgery, Third Hospital Peking University, Beijing, China
| | - Shaoxing Zhang
- Department of Otorhinolarygology Head and Neck Surgery, Third Hospital Peking University, Beijing, China
| | - Changsheng Li
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Yunfeng Zhu
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Lei Hu
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Furong Ma
- Department of Otorhinolarygology Head and Neck Surgery, Third Hospital Peking University, Beijing, China
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Bernardeschi D, Nguyen Y, Villepelet A, Ferrary E, Mazalaigue S, Kalamarides M, Sterkers O. Use of bone anchoring device in electromagnetic computer-assisted navigation in lateral skull base surgery. Acta Otolaryngol 2013; 133:1047-52. [PMID: 23941593 DOI: 10.3109/00016489.2013.808764] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The use of the bone anchoring device associated with a fiducial marker, both fixed close to the operating field, improves the reproducibility and effectiveness of the computer-assisted navigation in lateral skull base surgery. OBJECTIVES Computer-assisted navigation in lateral skull base surgery using the electromagnetic system Digipointeur(®) needs an external fiducial marker (titanium screw) close to the operating field to increase position accuracy (PA) to about 1 mm. Displacement of the emitter placed in the mouth (Buccostat(®)) induces a drift of the system, leading to at least 20% of unsuccessful procedures. The aim of this study was to evaluate the PA, stability, and reproducibility of computer-assisted navigation in lateral skull base surgery using a bone anchoring device to provide a fixed registration system near the operating field. METHODS Forty patients undergoing a lateral skull base procedure with the Digipointeur(®) system performed with both the titanium screw and bone anchoring device were included in this prospective study. They were divided in two groups. In the first one (n = 9), the PA was measured before and after screw registration for five intratemporal landmarks, during a translabyrinthine approach. In the second group (n = 31), all lateral skull base procedures were included and the PA was evaluated visually by the surgeon on different landmarks of the approaches as well as the stability of the system. RESULTS In the first group, the PA was 7.08 ± 0.59 mm and 0.77 ± 0.17 mm (mean ± SEM, p < 0.0001) before and after screw registration, respectively. In the second group, the PA was considered as accurate by the surgeon in all cases and no drift of the system was observed. Computer-assisted surgery was never abandoned due to increased stability of the bone-anchored emitter.
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Voormolen EHJ, van Stralen M, Woerdeman PA, Pluim JPW, Noordmans HJ, Viergever MA, Regli L, Berkelbach van der Sprenkel JW. Determination of a facial nerve safety zone for navigated temporal bone surgery. Neurosurgery 2012; 70:50-60; discussion 60. [PMID: 21909042 DOI: 10.1227/neu.0b013e31822e7fc3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Transtemporal approaches require surgeons to drill the temporal bone to expose target lesions while avoiding the critical structures within it, such as the facial nerve and other neurovascular structures. We envision a novel protective neuronavigation system that continuously calculates the drill tip-to-facial nerve distance intraoperatively and produces audiovisual warnings if the surgeon drills too close to the facial nerve. Two major problems need to be solved before such a system can be realized. OBJECTIVE To solve the problems of (1) facial nerve segmentation and (2) calculating a safety zone around the facial nerve in relation to drill-tip tracking inaccuracies. METHODS We developed a new algorithm called NerveClick for semiautomatic segmentation of the intratemporal facial nerve centerline from temporal bone computed tomography images. We evaluated NerveClick's accuracy in an experimental setting of neuro-otologic and neurosurgical patients. Three neurosurgeons used it to segment 126 facial nerves, which were compared with the gold standard: manually segmented facial nerve centerlines. The centerlines are used as a central axis around which a tubular safety zone is built. The zone's thickness incorporates the drill tip tracking errors. The system will warn when the tracked tip crosses the safety zone. RESULTS Neurosurgeons using NerveClick could segment facial nerve centerlines with a maximum error of 0.44 ± 0.23 mm (mean ± standard deviation) on average compared with manual segmentations. CONCLUSION Neurosurgeons using our new NerveClick algorithm can robustly segment facial nerve centerlines to construct a facial nerve safety zone, which potentially allows timely audiovisual warnings during navigated temporal bone drilling despite tracking inaccuracies.
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Affiliation(s)
- Eduard H J Voormolen
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
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Kohan D, Jethanamest D. Image-guided surgical navigation in otology. Laryngoscope 2012; 122:2291-9. [PMID: 22961537 DOI: 10.1002/lary.23522] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 05/23/2012] [Accepted: 05/24/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the efficacy of image-guided surgical navigation (IGSN) in otologic surgery and establish practice guidelines. STUDY DESIGN Prospective study. METHODS Between January 2003 and January 2010, all patients requiring complicated surgery for chronic otitis media, glomus jugulare, atresia, cerebrospinal fluid leak with or without encephalocele, and cholesterol granuloma of the petrous apex were offered IGSN. The accuracy of IGSN relative to pertinent pathology and 11 anatomic landmarks was established. Additionally IGSN-related operative time, complications, and surgical outcome were recorded. RESULTS In the study period there were 820 otologic procedures, among 94 patients (96 ears) with disease meeting proposed criteria. Thirteen patients (15 procedures) consented to the use of IGSN. All patients had a minimum 6 months of follow-up. The average additional operative time required was 36.7 minutes. The mean accuracy error was 1.1 mm laterally at the tragus but decreased to 0.8 mm medially at the level of the oval window. The mean accuracy of IGSN was within 1 mm in 10 of the 11 targeted surgical anatomic landmarks. CONCLUSIONS Interactive image-guided surgical navigation during complex otologic surgery may improve surgical outcome and decrease morbidity by providing an accurate real-time display of surgical instrumentation relative to patient anatomy and pathology. In select cases, the extra cost of imaging immediately prior to surgery and extra operating room time may be compensated by enhancing the ability to distinguish distorted anatomy relative to disease, potentially improving surgical outcome. IGSN, although useful, does not replace surgical expertise and experience.
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Affiliation(s)
- Darius Kohan
- Department of Otolaryngology, New York University School of Medicine, New York, New York, USA.
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13
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Voormolen EHJ, Woerdeman PA, van Stralen M, Noordmans HJ, Viergever MA, Regli L, van der Sprenkel JWB. Validation of exposure visualization and audible distance emission for navigated temporal bone drilling in phantoms. PLoS One 2012; 7:e41262. [PMID: 22848452 PMCID: PMC3405126 DOI: 10.1371/journal.pone.0041262] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 06/22/2012] [Indexed: 01/31/2023] Open
Abstract
Background A neuronavigation interface with extended function as compared with current systems was developed to aid during temporal bone surgery. The interface, named EVADE, updates the prior anatomical image and visualizes the bone drilling process virtually in real-time without need for intra-operative imaging. Furthermore, EVADE continuously calculates the distance from the drill tip to segmented temporal bone critical structures (e.g. the sigmoid sinus and facial nerve) and produces audiovisual warnings if the surgeon drills in too close vicinity. The aim of this study was to evaluate the accuracy and surgical utility of EVADE in physical phantoms. Methodology/Principal Findings We performed 228 measurements assessing the position accuracy of tracking a navigated drill in the operating theatre. A mean target registration error of 1.33±0.61 mm with a maximum error of 3.04 mm was found. Five neurosurgeons each drilled two temporal bone phantoms, once using EVADE, and once using a standard neuronavigation interface. While using standard neuronavigation the surgeons damaged three modeled temporal bone critical structures. No structure was hit by surgeons utilizing EVADE. Surgeons felt better orientated and thought they had improved tumor exposure with EVADE. Furthermore, we compared the distances between surface meshes of the virtual drill cavities created by EVADE to actual drill cavities: average maximum errors of 2.54±0.49 mm and −2.70±0.48 mm were found. Conclusions/Significance These results demonstrate that EVADE gives accurate feedback which reduces risks of harming modeled critical structures compared to a standard neuronavigation interface during temporal bone phantom drilling.
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Affiliation(s)
- Eduard H J Voormolen
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
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Vlantis AC, Chan H, Hung T, Tong MC, van Hasselt CA. The frontal bone skull post for image guided surgery of the nasopharynx. J Surg Oncol 2008; 97:551-2. [DOI: 10.1002/jso.21005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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