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Isikay I, Cekic E, Baylarov B, Tunc O, Hanalioglu S. Narrative review of patient-specific 3D visualization and reality technologies in skull base neurosurgery: enhancements in surgical training, planning, and navigation. Front Surg 2024; 11:1427844. [PMID: 39081485 PMCID: PMC11287220 DOI: 10.3389/fsurg.2024.1427844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/02/2024] [Indexed: 08/02/2024] Open
Abstract
Recent advances in medical imaging, computer vision, 3-dimensional (3D) modeling, and artificial intelligence (AI) integrated technologies paved the way for generating patient-specific, realistic 3D visualization of pathological anatomy in neurosurgical conditions. Immersive surgical simulations through augmented reality (AR), virtual reality (VR), mixed reality (MxR), extended reality (XR), and 3D printing applications further increased their utilization in current surgical practice and training. This narrative review investigates state-of-the-art studies, the limitations of these technologies, and future directions for them in the field of skull base surgery. We begin with a methodology summary to create accurate 3D models customized for each patient by combining several imaging modalities. Then, we explore how these models are employed in surgical planning simulations and real-time navigation systems in surgical procedures involving the anterior, middle, and posterior cranial skull bases, including endoscopic and open microsurgical operations. We also evaluate their influence on surgical decision-making, performance, and education. Accumulating evidence demonstrates that these technologies can enhance the visibility of the neuroanatomical structures situated at the cranial base and assist surgeons in preoperative planning and intraoperative navigation, thus showing great potential to improve surgical results and reduce complications. Maximum effectiveness can be achieved in approach selection, patient positioning, craniotomy placement, anti-target avoidance, and comprehension of spatial interrelationships of neurovascular structures. Finally, we present the obstacles and possible future paths for the broader implementation of these groundbreaking methods in neurosurgery, highlighting the importance of ongoing technological advancements and interdisciplinary collaboration to improve the accuracy and usefulness of 3D visualization and reality technologies in skull base surgeries.
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Affiliation(s)
- Ilkay Isikay
- Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Efecan Cekic
- Neurosurgery Clinic, Polatli Duatepe State Hospital, Ankara, Türkiye
| | - Baylar Baylarov
- Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Osman Tunc
- Btech Innovation, METU Technopark, Ankara, Türkiye
| | - Sahin Hanalioglu
- Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
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Bartholomew RA, Zhou H, Boreel M, Suresh K, Gupta S, Mitchell MB, Hong C, Lee SE, Smith TR, Guenette JP, Corrales CE, Jagadeesan J. Surgical Navigation in the Anterior Skull Base Using 3-Dimensional Endoscopy and Surface Reconstruction. JAMA Otolaryngol Head Neck Surg 2024; 150:318-326. [PMID: 38451508 PMCID: PMC11009826 DOI: 10.1001/jamaoto.2024.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/07/2024] [Indexed: 03/08/2024]
Abstract
Importance Image guidance is an important adjunct for endoscopic sinus and skull base surgery. However, current systems require bulky external tracking equipment, and their use can interrupt efficient surgical workflow. Objective To evaluate a trackerless surgical navigation system using 3-dimensional (3D) endoscopy and simultaneous localization and mapping (SLAM) algorithms in the anterior skull base. Design, Setting, and Participants This interventional deceased donor cohort study and retrospective clinical case study was conducted at a tertiary academic medical center with human deceased donor specimens and a patient with anterior skull base pathology. Exposures Participants underwent endoscopic endonasal transsphenoidal dissection and surface model reconstruction from stereoscopic video with registration to volumetric models segmented from computed tomography (CT) and magnetic resonance imaging. Main Outcomes and Measures To assess the fidelity of surface model reconstruction and accuracy of surgical navigation and surface-CT model coregistration, 3 metrics were calculated: reconstruction error, registration error, and localization error. Results In deceased donor models (n = 9), high-fidelity surface models of the posterior wall of the sphenoid sinus were reconstructed from stereoscopic video and coregistered to corresponding volumetric CT models. The mean (SD; range) reconstruction, registration, and localization errors were 0.60 (0.24; 0.36-0.93), 1.11 (0.49; 0.71-1.56) and 1.01 (0.17; 0.78-1.25) mm, respectively. In a clinical case study of a patient who underwent a 3D endoscopic endonasal transsphenoidal resection of a tubercular meningioma, a high-fidelity surface model of the posterior wall of the sphenoid was reconstructed from intraoperative stereoscopic video and coregistered to a volumetric preoperative fused CT magnetic resonance imaging model with a root-mean-square error of 1.38 mm. Conclusions and Relevance The results of this study suggest that SLAM algorithm-based endoscopic endonasal surgery navigation is a novel, accurate, and trackerless approach to surgical navigation that uses 3D endoscopy and SLAM-based algorithms in lieu of conventional optical or electromagnetic tracking. While multiple challenges remain before clinical readiness, a SLAM algorithm-based endoscopic endonasal surgery navigation system has the potential to improve surgical efficiency, economy of motion, and safety.
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Affiliation(s)
- Ryan A. Bartholomew
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Haoyin Zhou
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Maud Boreel
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Krish Suresh
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Saksham Gupta
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Margaret B. Mitchell
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Christopher Hong
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Stella E. Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Timothy R. Smith
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jeffrey P. Guenette
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - C. Eduardo Corrales
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jayender Jagadeesan
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
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Rosvall BR, Choby GW. Navigating the Nose-The Future of Endoscopic Endonasal Surgical Navigation. JAMA Otolaryngol Head Neck Surg 2024; 150:326-327. [PMID: 38451546 DOI: 10.1001/jamaoto.2024.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Affiliation(s)
- Brandon R Rosvall
- Department of Otolaryngology-Head and Neck Surgery, Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Garret W Choby
- Department of Otolaryngology-Head and Neck Surgery, Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Neurological Surgery, Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Begagić E, Bečulić H, Pugonja R, Memić Z, Balogun S, Džidić-Krivić A, Milanović E, Salković N, Nuhović A, Skomorac R, Sefo H, Pojskić M. Augmented Reality Integration in Skull Base Neurosurgery: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:335. [PMID: 38399622 PMCID: PMC10889940 DOI: 10.3390/medicina60020335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: To investigate the role of augmented reality (AR) in skull base (SB) neurosurgery. Materials and Methods: Utilizing PRISMA methodology, PubMed and Scopus databases were explored to extract data related to AR integration in SB surgery. Results: The majority of 19 included studies (42.1%) were conducted in the United States, with a focus on the last five years (77.8%). Categorization included phantom skull models (31.2%, n = 6), human cadavers (15.8%, n = 3), or human patients (52.6%, n = 10). Microscopic surgery was the predominant modality in 10 studies (52.6%). Of the 19 studies, surgical modality was specified in 18, with microscopic surgery being predominant (52.6%). Most studies used only CT as the data source (n = 9; 47.4%), and optical tracking was the prevalent tracking modality (n = 9; 47.3%). The Target Registration Error (TRE) spanned from 0.55 to 10.62 mm. Conclusion: Despite variations in Target Registration Error (TRE) values, the studies highlighted successful outcomes and minimal complications. Challenges, such as device practicality and data security, were acknowledged, but the application of low-cost AR devices suggests broader feasibility.
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Affiliation(s)
- Emir Begagić
- Department of General Medicine, School of Medicine, University of Zenica, Travnička 1, 72000 Zenica, Bosnia and Herzegovina;
| | - Hakija Bečulić
- Department of Neurosurgery, Cantonal Hospital Zenica, Crkvice 67, 72000 Zenica, Bosnia and Herzegovina; (H.B.)
- Department of Anatomy, School of Medicine, University of Zenica, Travnička 1, 72000 Zenica, Bosnia and Herzegovina;
| | - Ragib Pugonja
- Department of Anatomy, School of Medicine, University of Zenica, Travnička 1, 72000 Zenica, Bosnia and Herzegovina;
| | - Zlatan Memić
- Department of General Medicine, School of Medicine, University of Zenica, Travnička 1, 72000 Zenica, Bosnia and Herzegovina;
| | - Simon Balogun
- Division of Neurosurgery, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ilesa Road PMB 5538, Ile-Ife 220282, Nigeria
| | - Amina Džidić-Krivić
- Department of Neurology, Cantonal Hospital Zenica, Crkvice 67, 72000 Zenica, Bosnia and Herzegovina
| | - Elma Milanović
- Neurology Clinic, Clinical Center University of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina
| | - Naida Salković
- Department of General Medicine, School of Medicine, University of Tuzla, Univerzitetska 1, 75000 Tuzla, Bosnia and Herzegovina;
| | - Adem Nuhović
- Department of General Medicine, School of Medicine, University of Sarajevo, Univerzitetska 1, 71000 Sarajevo, Bosnia and Herzegovina;
| | - Rasim Skomorac
- Department of Neurosurgery, Cantonal Hospital Zenica, Crkvice 67, 72000 Zenica, Bosnia and Herzegovina; (H.B.)
- Department of Surgery, School of Medicine, University of Zenica, Travnička 1, 72000 Zenica, Bosnia and Herzegovina
| | - Haso Sefo
- Neurosurgery Clinic, Clinical Center University of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina
| | - Mirza Pojskić
- Department of Neurosurgery, University Hospital Marburg, Baldingerstr., 35033 Marburg, Germany
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Campisi BM, Costanzo R, Gulino V, Avallone C, Noto M, Bonosi L, Brunasso L, Scalia G, Iacopino DG, Maugeri R. The Role of Augmented Reality Neuronavigation in Transsphenoidal Surgery: A Systematic Review. Brain Sci 2023; 13:1695. [PMID: 38137143 PMCID: PMC10741598 DOI: 10.3390/brainsci13121695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
In the field of minimally invasive neurosurgery, microscopic transsphenoidal surgery (MTS) and endoscopic transsphenoidal surgery (ETS) have been widely accepted as a safe approach for pituitary lesions and, more recently, their indications have been extended to lesions at various skull base regions. It is mandatory during transsphenoidal surgery (TS) to identify key anatomical landmarks in the sphenoid sinus and distinguish them from the lesion. Over the years, many intraoperative tools have been introduced to improve the neuronavigation systems aiming to achieve safer and more accurate neurosurgical interventions. However, traditional neuronavigation systems may lose the accuracy of real-time location due to the discrepancy between the actual surgical field and the preoperative 2D images. To deal with this, augmented reality (AR)-a new sophisticated 3D technology that superimposes computer-generated virtual objects onto the user's view of the real world-has been considered a promising tool. Particularly, in the field of TS, AR can minimize the anatomic challenges of traditional endoscopic or microscopic surgery, aiding in surgical training, preoperative planning and intra-operative orientation. The aim of this systematic review is to analyze the potential future role of augmented reality, both in endoscopic and microscopic transsphenoidal surgeries.
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Affiliation(s)
- Benedetta Maria Campisi
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Roberta Costanzo
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Vincenzo Gulino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Chiara Avallone
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Manfredi Noto
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Lapo Bonosi
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Lara Brunasso
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck Surgery, Garibaldi Hospital, 95122 Catania, Italy;
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
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El Chemaly T, Athayde Neves C, Leuze C, Hargreaves B, H Blevins N. Stereoscopic calibration for augmented reality visualization in microscopic surgery. Int J Comput Assist Radiol Surg 2023; 18:2033-2041. [PMID: 37450175 DOI: 10.1007/s11548-023-02980-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/26/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Middle and inner ear procedures target hearing loss, infections, and tumors of the temporal bone and lateral skull base. Despite the advances in surgical techniques, these procedures remain challenging due to limited haptic and visual feedback. Augmented reality (AR) may improve operative safety by allowing the 3D visualization of anatomical structures from preoperative computed tomography (CT) scans on real intraoperative microscope video feed. The purpose of this work was to develop a real-time CT-augmented stereo microscope system using camera calibration and electromagnetic (EM) tracking. METHODS A 3D printed and electromagnetically tracked calibration board was used to compute the intrinsic and extrinsic parameters of the surgical stereo microscope. These parameters were used to establish a transformation between the EM tracker coordinate system and the stereo microscope image space such that any tracked 3D point can be projected onto the left and right images of the microscope video stream. This allowed the augmentation of the microscope feed of a 3D printed temporal bone with its corresponding CT-derived virtual model. Finally, the calibration board was also used for evaluating the accuracy of the calibration. RESULTS We evaluated the accuracy of the system by calculating the registration error (RE) in 2D and 3D in a microsurgical laboratory setting. Our calibration workflow achieved a RE of 0.11 ± 0.06 mm in 2D and 0.98 ± 0.13 mm in 3D. In addition, we overlaid a 3D CT model on the microscope feed of a 3D resin printed model of a segmented temporal bone. The system exhibited small latency and good registration accuracy. CONCLUSION We present the calibration of an electromagnetically tracked surgical stereo microscope for augmented reality visualization. The calibration method achieved accuracy within a range suitable for otologic procedures. The AR process introduces enhanced visualization of the surgical field while allowing depth perception.
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Affiliation(s)
- Trishia El Chemaly
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
- Department of Otolaryngology, Stanford School of Medicine, Stanford, CA, USA.
- Department of Radiology, Stanford School of Medicine, Stanford, CA, USA.
| | - Caio Athayde Neves
- Department of Otolaryngology, Stanford School of Medicine, Stanford, CA, USA
- Faculty of Medicine, University of Brasília, Brasília, Brazil
| | - Christoph Leuze
- Department of Radiology, Stanford School of Medicine, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Brian Hargreaves
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford School of Medicine, Stanford, CA, USA
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Nikolas H Blevins
- Department of Otolaryngology, Stanford School of Medicine, Stanford, CA, USA
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Begaud L, Patron V, Escalard C, Hitier M, Hamon M, Humbert M. Radiological relationship of the ethmoid slit with the frontal sinus and the anterior ethmoidal artery and applications to the frontal sinus drillout. Eur Arch Otorhinolaryngol 2023; 280:227-233. [PMID: 35771279 DOI: 10.1007/s00405-022-07527-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/24/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To compare two types of CT acquisition parameters: CT scan of the facial bone and CT scan of the sinuses, for studying the ethmoidal slit and its relationship with the frontal sinus and anterior ethmoidal artery. MATERIALS AND METHODS Retrospective study of 145 scans of the sinuses and 79 of the facial bones performed between 2012 and 2016. On each scan, the visibility of the ethmoidal slits, their length, their distance from the ethmoidal artery, and their relationship with the anterior and posterior wall of the frontal sinus were studied. RESULTS The ethmoidal slit was better visualized on CT scans of the facial bone (58.2%) than on those of the sinuses (43.1%) (p = 0.02). The distance between the anterior ethmoidal artery and the anterior part of the cribriform plate was 9.3 mm for CT scans of the facial bone and 8.4 mm for CT scans of the sinuses. The theoretical risk of damaging the glabellar soft tissue and that of damaging the meninges during a frontal sinusotomy was evaluated, respectively, at 9.6% and 26.1% for CT scans of the facial bone, and at 6.2% and 21.5% for sinus scans. CONCLUSIONS CT scans of the facial bone are better than CT scans of the sinuses for identifying ethmoidal slits and their distance from the canal of the anterior ethmoidal artery. The identification of these elements is relevant for the surgeon during frontal sinus surgery and makes it possible to assess the risk of damaging the glabellar soft tissue or meninges. Performing a CT scan of the facial bone seems preferable to that of a CT scan of the sinuses in certain pathological situations, such as cerebrospinal rhinorrhea or revision surgeries of the frontal sinus.
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Affiliation(s)
- Laurie Begaud
- Department of Radiology, CHU de Caen, 14000, Caen, France
| | - Vincent Patron
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France.
| | | | - Martin Hitier
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France.,Department Anatomy, UNICAEN, 14032, Caen, France
| | - Michèle Hamon
- Department of Radiology, CHU de Caen, 14000, Caen, France
| | - Maxime Humbert
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France
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Zagzoog N, Rastgarjazi S, Ramjist J, Lui J, Hopfgartner A, Jivraj J, Yeretsian T, Zadeh G, Lin V, Yang VXD. Pilot Study of Optical Topographic Imaging Based Neuronavigation for Mastoidectomy. World Neurosurg 2022; 166:e790-e798. [PMID: 35953033 DOI: 10.1016/j.wneu.2022.07.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mastoidectomy involves drilling the temporal bone while avoiding the facial nerve, semicircular canals, sigmoid sinus, and tegmen. Optical topographic imaging (OTI) is a novel registration technique that allows rapid registration with minimal navigational error. To date, no studies have examined the use of OTI in skull-base procedures. METHODS In this cadaveric study, 8 mastoidectomies were performed in 2 groups-4 free-hand (FH) and 4 OTI-assisted mastoidectomies. Registration accuracy for OTI navigation was quantified with root mean square (RMS) and target registration error (TRE). Procedural time, percent of mastoid resected, and the proximity of the mastoidectomy cavity to critical structures were determined. RESULTS The average RMS and TRE associated with OTI-based registration were 1.44 mm (±0.83 mm) and 2.17 mm (±0.89 mm), respectively. The volume removed, expressed as a percentage of the total mastoid volume, was 37.5% (±10.2%) versus 31.2% (±2.3%), P = 0.31, for FH and OTI-assisted mastoidectomy. There were no statistically significant differences between FH and OTI-assisted mastoidectomies with respect to proximity to critical structures or procedural time. CONCLUSIONS This work is the first examining the application of OTI neuronavigation in lateral skull-base procedures. This pilot study revealed the RMS and TRE for OTI-based navigation in the lateral skull base are 1.44 mm (±0.83 mm) and 2.17 mm (±0.89 mm), respectively. This pilot study demonstrates that an OTI-based system is sufficiently accurate and may address barriers to widespread adoption of navigation for lateral skull-base procedures.
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Affiliation(s)
- Nirmeen Zagzoog
- Institute of Medical Science, School of Graduate Studies, Faculty of Medicine, Toronto, Ontario, Canada; Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada.
| | - Siavash Rastgarjazi
- Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada
| | - Joel Ramjist
- Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada
| | - Justin Lui
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Otolaryngology, Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Adam Hopfgartner
- Orthopedic Biomechanics Laboratory, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jamil Jivraj
- Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada
| | - Tiffany Yeretsian
- Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Vincent Lin
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Victor X D Yang
- Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Boekestijn I, van Oosterom MN, Dell'Oglio P, van Velden FHP, Pool M, Maurer T, Rietbergen DDD, Buckle T, van Leeuwen FWB. The current status and future prospects for molecular imaging-guided precision surgery. Cancer Imaging 2022; 22:48. [PMID: 36068619 PMCID: PMC9446692 DOI: 10.1186/s40644-022-00482-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/21/2022] [Indexed: 01/19/2023] Open
Abstract
Molecular imaging technologies are increasingly used to diagnose, monitor, and guide treatment of i.e., cancer. In this review, the current status and future prospects of the use of molecular imaging as an instrument to help realize precision surgery is addressed with focus on the main components that form the conceptual basis of intraoperative molecular imaging. Paramount for successful interventions is the relevance and accessibility of surgical targets. In addition, selection of the correct combination of imaging agents and modalities is critical to visualize both microscopic and bulk disease sites with high affinity and specificity. In this context developments within engineering/imaging physics continue to drive the growth of image-guided surgery. Particularly important herein is enhancement of sensitivity through improved contrast and spatial resolution, features that are critical if sites of cancer involvement are not to be overlooked during surgery. By facilitating the connection between surgical planning and surgical execution, digital surgery technologies such as computer-aided visualization nicely complement these technologies. The complexity of image guidance, combined with the plurality of technologies that are becoming available, also drives the need for evaluation mechanisms that can objectively score the impact that technologies exert on the performance of healthcare professionals and outcome improvement for patients.
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Affiliation(s)
- Imke Boekestijn
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paolo Dell'Oglio
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Floris H P van Velden
- Medical Physics, Department of Radiology , Leiden University Medical Center, Leiden, the Netherlands
| | - Martin Pool
- Department of Clinical Farmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Centre Hamburg, Hamburg, Germany
| | - Daphne D D Rietbergen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
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10
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Kalaiarasan K, Prathap L, Ayyadurai M, Subhashini P, Tamilselvi T, Avudaiappan T, Infant Raj I, Alemayehu Mamo S, Mezni A. Clinical Application of Augmented Reality in Computerized Skull Base Surgery. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:1335820. [PMID: 35600956 PMCID: PMC9117015 DOI: 10.1155/2022/1335820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/19/2022] [Indexed: 12/02/2022]
Abstract
Cranial base tactics comprise the regulation of tiny and complicated structures in the domains of otology, rhinology, neurosurgery, and maxillofacial medical procedure. Basic nerves and veins are in the nearness of these buildings. Increased the truth is a coming innovation that may reform the cerebral basis approach by supplying vital physical and navigational facts brought together in a solitary presentation. In any case, the awareness and acknowledgment of prospective results of expanding reality frameworks in the cerebral base region are really poor. This article targets examining the handiness of expanded reality frameworks in cranial foundation medical procedures and emphasizes the obstacles that present innovation encounters and their prospective adjustments. A specialized perspective on distinct strategies used being produced of an improved realty framework is furthermore offered. The newest item offers an expansion in interest in expanded reality frameworks that may motivate more secure and practical procedures. In any case, a couple of concerns have to be cared to before that can be for the vast part fused into normal practice.
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Affiliation(s)
- K. Kalaiarasan
- Department of Information Technology, M. Kumarasamy College of Engineering, Karur, India
| | - Lavanya Prathap
- Department of Anatomy, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu 600077, India
| | - M. Ayyadurai
- SG, Institute of ECE, Saveetha School of Engineering, SIMATS, Chennai, Tamil Nadu 600077, India
| | - P. Subhashini
- Department of Computer Science and Engineering, J.N.N Institute of Engineering, Kannigaipair, Tamil Nadu 601102, India
| | - T. Tamilselvi
- Department of Computer Science and Engineering, Panimalar Institute of Technology, Varadarajapuram, Tamil Nadu 600123, India
| | - T. Avudaiappan
- Computer Science and Engineering, K. Ramakrishnan College of Technology, Trichy 621112, India
| | - I. Infant Raj
- Department of Computer Science and Engineering, K. Ramakrishnan College of Engineering, Trichy, India
| | - Samson Alemayehu Mamo
- Department of Electrical and Computer Engineering, Faculty of Electrical and Biomedical Engineering, Institute of Technology, Hawassa University, Awasa, Ethiopia
| | - Amine Mezni
- Department of Chemistry, College of Science, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
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11
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Yoo H, Sim T. Automated Machine Learning (AutoML)-based Surface Registration Methodology for Image-guided Surgical Navigation System. Med Phys 2022; 49:4845-4860. [PMID: 35543150 DOI: 10.1002/mp.15696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND While the surface registration technique has the advantage of being relatively safe and the operation time is short, it generally has the disadvantage of low accuracy. PURPOSE This research proposes automated machine learning (AutoML)-based surface registration to improve the accuracy of image-guided surgical navigation systems. METHODS The state-of-the-art surface registration concept is that first, using a neural network model, a new point-cloud that matches the facial information acquired by a passive probe of an optical tracking system (OTS) is extracted from the facial information obtained by computerized tomography (CT). Target registration error (TRE) representing the accuracy of surface registration is then calculated by applying the iterative closest point (ICP) algorithm to the newly extracted point-cloud and OTS information. In this process, the hyperparameters used in the neural network model and ICP algorithm are automatically optimized using Bayesian Optimization with Expected Improvement to yield improved registration accuracy. RESULTS Using the proposed surface registration methodology, the average TRE for the targets located in the sinus space and nasal cavity of the soft phantoms is (0.939 ± 0.375) mm, which shows 57.8 % improvement compared to the average TRE of (2.227 ± 0.193) mm calculated by the conventional surface registration method (p < 0.01). The performance of the proposed methodology is evaluated, and the average TREs computed by the proposed methodology and the conventional method are (0.767 ± 0.132) mm and (2.615 ± 0.378) mm, respectively. Additionally, for one healthy adult, the clinical applicability of the AutoML-based surface registration is also presented. CONCLUSION Our findings showed that the registration accuracy could be improved while maintaining the advantages of the surface registration technique. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hakje Yoo
- Korea University Research Institute for Medical Bigdata Science, College of Medicine, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Taeyong Sim
- Department of Artificial Intelligence, Sejong University, 209, Neungdong-ro, Gwangjin-gu, Seoul, 05006, Republic of Korea
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12
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Taboni S, Ferrari M, Daly MJ, Chan HHL, Eu D, Gualtieri T, Jethwa AR, Sahovaler A, Sewell A, Hasan W, Berania I, Qiu J, de Almeida J, Nicolai P, Gilbert RW, Irish JC. Navigation-Guided Transnasal Endoscopic Delineation of the Posterior Margin for Maxillary Sinus Cancers: A Preclinical Study. Front Oncol 2021; 11:747227. [PMID: 34858824 PMCID: PMC8632239 DOI: 10.3389/fonc.2021.747227] [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: 07/25/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background The resection of advanced maxillary sinus cancers can be challenging due to the anatomical proximity to surrounding critical anatomical structures. Transnasal endoscopy can effectively aid the delineation of the posterior margin of resection. Implementation with 3D-rendered surgical navigation with virtual endoscopy (3D-SNVE) may represent a step forward. This study aimed to demonstrate and quantify the benefits of this technology. Material and Method Four maxillary tumor models with critical posterior extension were created in four artificial skulls (Sawbones®). Images were acquired with cone-beam computed tomography and the tumor and carotid were contoured. Eight head and neck surgeons were recruited for the simulations. Surgeons delineated the posterior margin of resection through a transnasal approach and avoided the carotid while establishing an adequate resection margin with respect to tumor extirpation. Three simulations were performed: 1) unguided: based on a pre-simulation study of cross-sectional imaging; 2) tumor-guided: guided by real-time tool tracking with 3D tumor and carotid rendering; 3) carotid-guided: tumor-guided with a 2-mm alert cloud surrounding the carotid. Distances of the planes from the carotid and tumor were classified as follows and the points of the plane were classified accordingly: “red”: through the carotid artery; “orange”: <2 mm from the carotid; “yellow”: >2 mm from the carotid and within the tumor or <5 mm from the tumor; “green”: >2 mm from the carotid and 5–10 mm from the tumor; and “blue”: >2 mm from the carotid and >10 mm from the tumor. The three techniques (unguided, tumor-guided, and carotid-guided) were compared. Results 3D-SNVE for the transnasal delineation of the posterior margin in maxillary tumor models significantly improved the rate of margin-negative clearance around the tumor and reduced damage to the carotid artery. “Green” cuts occurred in 52.4% in the unguided setting versus 62.1% and 64.9% in the tumor- and carotid-guided settings, respectively (p < 0.0001). “Red” cuts occurred 6.7% of the time in the unguided setting versus 0.9% and 1.0% in the tumor- and carotid-guided settings, respectively (p < 0.0001). Conclusions This preclinical study has demonstrated that 3D-SNVE provides a substantial improvement of the posterior margin delineation in terms of safety and oncological adequacy. Translation into the clinical setting, with a meticulous assessment of the oncological outcomes, will be the proposed next step.
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Affiliation(s)
- Stefano Taboni
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", Padua, Italy.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, Toronto, ON, Canada.,Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", Padua, Italy.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, Toronto, ON, Canada.,Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Donovan Eu
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Tommaso Gualtieri
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Ashok R Jethwa
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Head & Neck Surgery, University College London Hospital, London, United Kingdom
| | - Andrew Sewell
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Wael Hasan
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Ilyes Berania
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - John de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", Padua, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
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13
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Tai Y, Gao B, Li Q, Yu Z, Zhu C, Chang V. Trustworthy and Intelligent COVID-19 Diagnostic IoMT Through XR and Deep-Learning-Based Clinic Data Access. IEEE INTERNET OF THINGS JOURNAL 2021; 8:15965-15976. [PMID: 35782175 PMCID: PMC8769002 DOI: 10.1109/jiot.2021.3055804] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/10/2021] [Accepted: 01/27/2021] [Indexed: 05/21/2023]
Abstract
This article presents a novel extended reality (XR) and deep-learning-based Internet-of-Medical-Things (IoMT) solution for the COVID-19 telemedicine diagnostic, which systematically combines virtual reality/augmented reality (AR) remote surgical plan/rehearse hardware, customized 5G cloud computing and deep learning algorithms to provide real-time COVID-19 treatment scheme clues. Compared to existing perception therapy techniques, our new technique can significantly improve performance and security. The system collected 25 clinic data from the 347 positive and 2270 negative COVID-19 patients in the Red Zone by 5G transmission. After that, a novel auxiliary classifier generative adversarial network-based intelligent prediction algorithm is conducted to train the new COVID-19 prediction model. Furthermore, The Copycat network is employed for the model stealing and attack for the IoMT to improve the security performance. To simplify the user interface and achieve an excellent user experience, we combined the Red Zone's guiding images with the Green Zone's view through the AR navigate clue by using 5G. The XR surgical plan/rehearse framework is designed, including all COVID-19 surgical requisite details that were developed with a real-time response guaranteed. The accuracy, recall, F1-score, and area under the ROC curve (AUC) area of our new IoMT were 0.92, 0.98, 0.95, and 0.98, respectively, which outperforms the existing perception techniques with significantly higher accuracy performance. The model stealing also has excellent performance, with the AUC area of 0.90 in Copycat slightly lower than the original model. This study suggests a new framework in the COVID-19 diagnostic integration and opens the new research about the integration of XR and deep learning for IoMT implementation.
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Affiliation(s)
- Yonghang Tai
- Yunnan Key Laboratory of Opto-Electronic Information TechnologyYunnan Normal UniversityKunming650500China
| | - Bixuan Gao
- Yunnan Key Laboratory of Opto-Electronic Information TechnologyYunnan Normal UniversityKunming650500China
| | - Qiong Li
- Yunnan Key Laboratory of Opto-Electronic Information TechnologyYunnan Normal UniversityKunming650500China
| | - Zhengtao Yu
- Faculty of Information Engineering and AutomationKunming University of Science and TechnologyKunming650093China
| | - Chunsheng Zhu
- Southern University of Science and TechnologyShenzhen518055China
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14
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Tai Y, Qian K, Huang X, Zhang J, Jan MA, Yu Z. Intelligent Intraoperative Haptic-AR Navigation for COVID-19 Lung Biopsy Using Deep Hybrid Model. IEEE TRANSACTIONS ON INDUSTRIAL INFORMATICS 2021; 17:6519-6527. [PMID: 37981912 PMCID: PMC8545008 DOI: 10.1109/tii.2021.3052788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/26/2020] [Accepted: 01/03/2021] [Indexed: 11/21/2023]
Abstract
A novel intelligent navigation technique for accurate image-guided COVID-19 lung biopsy is addressed, which systematically combines augmented reality (AR), customized haptic-enabled surgical tools, and deep neural network to achieve customized surgical navigation. Clinic data from 341 COVID-19 positive patients, with 1598 negative control group, have collected for the model synergy and evaluation. Biomechanics force data from the experiment are applied a WPD-CNN-LSTM (WCL) to learn a new patient-specific COVID-19 surgical model, and the ResNet was employed for the intraoperative force classification. To boost the user immersion and promote the user experience, intro-operational guiding images have combined with the haptic-AR navigational view. Furthermore, a 3-D user interface (3DUI), including all requisite surgical details, was developed with a real-time response guaranteed. Twenty-four thoracic surgeons were invited to the objective and subjective experiments for performance evaluation. The root-mean-square error results of our proposed WCL model is 0.0128, and the classification accuracy is 97%, which demonstrated that the innovative AR with deep learning (DL) intelligent model outperforms the existing perception navigation techniques with significantly higher performance. This article shows a novel framework in the interventional surgical integration for COVID-19 and opens the new research about the integration of AR, haptic rendering, and deep learning for surgical navigation.
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Affiliation(s)
- Yonghang Tai
- Yunnan Key Laboratory of Opto-Electronic Information TechnologyYunnan Normal UniversityKunming650500China
| | - Kai Qian
- Department of Thoracic SurgeryYunnan First People's HospitalKunming650000China
| | - Xiaoqiao Huang
- Yunnan Key Laboratory of Opto-Electronic Information TechnologyYunnan Normal UniversityKunming650500China
| | - Jun Zhang
- Yunnan Key Laboratory of Opto-Electronic Information TechnologyYunnan Normal UniversityKunming650500China
| | | | - Zhengtao Yu
- Faculty of Information Engineering and AutomationKunming University of Science and TechnologyKunming650093China
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15
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Skyrman S, Lai M, Edström E, Burström G, Förander P, Homan R, Kor F, Holthuizen R, Hendriks BHW, Persson O, Elmi-Terander A. Augmented reality navigation for cranial biopsy and external ventricular drain insertion. Neurosurg Focus 2021; 51:E7. [PMID: 34333469 DOI: 10.3171/2021.5.focus20813] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the accuracy (deviation from the target or intended path) and efficacy (insertion time) of an augmented reality surgical navigation (ARSN) system for insertion of biopsy needles and external ventricular drains (EVDs), two common neurosurgical procedures that require high precision. METHODS The hybrid operating room-based ARSN system, comprising a robotic C-arm with intraoperative cone-beam CT (CBCT) and integrated video tracking of the patient and instruments using nonobtrusive adhesive optical markers, was used. A 3D-printed skull phantom with a realistic gelatinous brain model containing air-filled ventricles and 2-mm spherical biopsy targets was obtained. After initial CBCT acquisition for target registration and planning, ARSN was used for 30 cranial biopsies and 10 EVD insertions. Needle positions were verified by CBCT. RESULTS The mean accuracy of the biopsy needle insertions (n = 30) was 0.8 mm ± 0.43 mm. The median path length was 39 mm (range 16-104 mm) and did not correlate to accuracy (p = 0.15). The median device insertion time was 149 seconds (range 87-233 seconds). The mean accuracy for the EVD insertions (n = 10) was 2.9 mm ± 0.8 mm at the tip with a 0.7° ± 0.5° angular deviation compared with the planned path, and the median insertion time was 188 seconds (range 135-400 seconds). CONCLUSIONS This study demonstrated that ARSN can be used for navigation of percutaneous cranial biopsies and EVDs with high accuracy and efficacy.
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Affiliation(s)
- Simon Skyrman
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marco Lai
- 2Philips Research, High Tech Campus 34, Eindhoven.,3Eindhoven University of Technology (TU/e), Eindhoven
| | - Erik Edström
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Burström
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Petter Förander
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Flip Kor
- 5Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | - Benno H W Hendriks
- 2Philips Research, High Tech Campus 34, Eindhoven.,5Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Oscar Persson
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Elmi-Terander
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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16
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 413] [Impact Index Per Article: 137.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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17
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Svajdova M, Sicak M, Dubinsky P, Slavik M, Slampa P, Kazda T. Recurrent Nasopharyngeal Cancer: Critical Review of Local Treatment Options Including Recommendations during the COVID-19 Pandemic. Cancers (Basel) 2020; 12:cancers12123510. [PMID: 33255751 PMCID: PMC7760235 DOI: 10.3390/cancers12123510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Options for the curative treatment of locally recurrent nasopharyngeal carcinoma include surgery or re-irradiation. Both approaches have been scientifically explored, yet there is no consensus on the indication or definitive preference of the above two salvage treatments. The aim of this review is to summarize the current evidence on the local treatment of recurrent nasopharyngeal carcinoma. The feasibility, safety, and efficacy of salvage surgery and radical re-irradiation are discussed. Recommendations on treatment modifications during the coronavirus disease 2019 pandemic are included as well. Abstract Recurrent nasopharyngeal carcinoma represents an extremely challenging therapeutic situation. Given the vulnerability of the already pretreated neurological structures surrounding the nasopharynx, any potential salvage retreatment option bears a significant risk of severe complications that result in high treatment-related morbidity, quality of life deterioration, and even mortality. Yet, with careful patient selection, long-term survival may be achieved after local retreatment in a subgroup of patients with local or regional relapse of nasopharyngeal cancer. Early detection of the recurrence represents the key to therapeutic success, and in the case of early stage disease, several curative treatment options can be offered to the patient, albeit with minimal support in prospective clinical data. In this article, an up-to-date review of published evidence on modern surgical and radiation therapy treatment options is summarized, including currently recommended treatment modifications of both therapeutic approaches during the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Michaela Svajdova
- Department of Radiation and Clinical Oncology, Central Military Hospital—Teaching Hospital Ruzomberok, 034 01 Ruzomberok, Slovakia
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
- Correspondence: ; Tel.: +421-911-618-265
| | - Marian Sicak
- Department of Otorhinolaryngology and Head and Neck Surgery, Central Military Hospital—Teaching Hospital, 034 01 Ruzomberok, Slovakia;
| | - Pavol Dubinsky
- Department of Radiation Oncology, East Slovakia Oncology Institute, 041 91 Kosice, Slovakia;
- Faculty of Health, Catholic University Ruzomberok, 034 01 Ruzomberok, Slovakia
| | - Marek Slavik
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (P.S.); (T.K.)
| | - Pavel Slampa
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (P.S.); (T.K.)
| | - Tomas Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (P.S.); (T.K.)
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Abstract
OBJECTIVE To test the feasibility of image-guided Baha Attract implant surgery with mixed reality (MR) in the form of the HoloLens to visualize critical structures and facilitate precise Baha implant placement. METHODS A cadaveric case study of bilateral Baha Attract implant approaches was conducted using Star Atlas MR three-dimensional (3D) medical interaction system guidance at the Otolaryngology Department of PUMCH, Beijing, China. The accuracy of visual surface registration was determined by the target registration error (TRE) between the predefined points on the preoperative 3D holographic Baha Attract implant model and the postoperatively reconstructed 3D model. RESULTS Bilateral Baha Attract implantation was completed successfully for all four cadaveric heads using the Star Atlas MR 3D medical interaction system with the HoloLens. The preoperative 3D digital model characteristics (including bone quality and thickness and avoidance of cranial vessels, air cells, and cranial sutures) corresponded well with the 3D model of the actual implantation reconstructed postoperatively. The median TRE of our system was 2.97 mm (ranging from 1.98 to 4.58 mm) in terms of distance and 2.76 degrees (ranging from 0.59 to 6.4 degrees) in terms of angle. CONCLUSIONS Applying MR technology in the form of the HoloLens in Baha Attract implant surgery is feasible and could improve the accuracy of the surgery. The described MR system for Baha Attract implantation has the potential to improve the surgeon's confidence, as well as the surgical safety, efficiency, and precision.
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Linxweiler M, Pillong L, Kopanja D, Kühn JP, Wagenpfeil S, Radosa JC, Wang J, Morris LGT, Al Kadah B, Bochen F, Körner S, Schick B. Augmented reality-enhanced navigation in endoscopic sinus surgery: A prospective, randomized, controlled clinical trial. Laryngoscope Investig Otolaryngol 2020; 5:621-629. [PMID: 32864433 PMCID: PMC7444769 DOI: 10.1002/lio2.436] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/11/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Endoscopic sinus surgery represents the gold standard for surgical treatment of chronic sinus diseases. Thereby, navigation systems can be of distinct use. In our study, we tested the recently developed KARL STORZ NAV1 SinusTracker navigation software that incorporates elements of augmented reality (AR) to provide a better preoperative planning and guidance during the surgical procedure. METHODS One hundred patients with chronic sinus disease were operated on using either a conventional navigation software (n = 52, non-AR, control group) or a navigation software incorporating AR elements (n = 48, AR, intervention group). Incidence of postoperative complications, duration of surgery, surgeon-reported benefit from the navigation system and patient-reported postoperative rehabilitation were assessed. RESULTS The surgeons reported a higher benefit during surgery, used the navigation system for more surgical steps and spent longer time with preoperative image analysis when using the AR system as compared with the non-AR system. No significant differences were seen in terms of postoperative complications, target registration error, operation time and postoperative rehabilitation. CONCLUSION The AR enhanced navigation software shows a high acceptance by sinus surgeons in different stages of surgical training and offers potential benefits during surgery without affecting the duration of the operation or the incidence of postoperative complications. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Maximilian Linxweiler
- Department of Otorhinolaryngology, Head and Neck SurgerySaarland University Medical CentreHomburgGermany
| | - Lukas Pillong
- Department of Otorhinolaryngology, Head and Neck SurgerySaarland University Medical CentreHomburgGermany
| | - Dragan Kopanja
- Department of Otorhinolaryngology, Head and Neck SurgerySaarland University Medical CentreHomburgGermany
| | - Jan P. Kühn
- Department of Otorhinolaryngology, Head and Neck SurgerySaarland University Medical CentreHomburgGermany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical InformaticsSaarland University Medical CentreHomburgGermany
| | - Julia C. Radosa
- Department of Gynecology, Obstetrics and Reproductive MedicineSaarland University Medical CentreHomburgGermany
| | - Jingming Wang
- Human Oncology and Pathogenesis ProgramMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Luc G. T. Morris
- Immunogenomics and Precision Oncology PlatformMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Basel Al Kadah
- Department of OtorhinolaryngologyBethanien HospitalPlauenGermany
| | - Florian Bochen
- Department of Otorhinolaryngology, Head and Neck SurgerySaarland University Medical CentreHomburgGermany
| | - Sandrina Körner
- Department of Otorhinolaryngology, Head and Neck SurgerySaarland University Medical CentreHomburgGermany
| | - Bernhard Schick
- Department of Otorhinolaryngology, Head and Neck SurgerySaarland University Medical CentreHomburgGermany
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20
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Early Feasibility Studies of Augmented Reality Navigation for Lateral Skull Base Surgery. Otol Neurotol 2020; 41:883-888. [DOI: 10.1097/mao.0000000000002724] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Chow VLY, Chan JYW, Wong STS, Wei WI. Recommendations for surgical management of recurrent nasopharyngeal carcinoma during COVID-19 pandemic. Laryngoscope Investig Otolaryngol 2020; 5:468-472. [PMID: 32596489 PMCID: PMC7314480 DOI: 10.1002/lio2.417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022] Open
Abstract
Nasopharyngeal carcinoma is endemic in southern parts of China including Hong Kong. Primary treatment entails radiotherapy ± chemotherapy depending on disease stage at presentation. Surgery is offered as a means of salvage for persistent and recurrent disease. Comprehensive preoperative work-up, careful patient selection, attention to details perioperation and multidisciplinary approach is essential in ensuring optimal outcomes after salvage surgery for recurrent nasopharyngeal carcinoma patients. Since the COVID-19 outbreak, we are faced with unprecedented challenges with priorities of care and resources being shifted to combat the virus. These include patient selection and timing of treatment, while preventing disease transmission to heath care providers. Practices and recommendations made in this document are intended to support safe clinical practice and efficient use of resources during this challenging time.
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Affiliation(s)
- Velda Ling Yu Chow
- Division of Head and Neck Surgery, Department of SurgeryUniversity of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary HospitalHong Kong SARChina
| | - Jimmy Yu Wai Chan
- Division of Head and Neck Surgery, Department of SurgeryUniversity of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary HospitalHong Kong SARChina
| | - Stanley Thian Sze Wong
- Division of Head and Neck Surgery, Department of SurgeryUniversity of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary HospitalHong Kong SARChina
| | - William Ignace Wei
- Division of Head and Neck Surgery, Department of SurgeryUniversity of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary HospitalHong Kong SARChina
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22
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Schmale IL, Vandelaar LJ, Luong AU, Citardi MJ, Yao WC. Image-Guided Surgery and Intraoperative Imaging in Rhinology: Clinical Update and Current State of the Art. EAR, NOSE & THROAT JOURNAL 2020; 100:NP475-NP486. [PMID: 32453646 DOI: 10.1177/0145561320928202] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Image-guided surgery (IGS) has gained widespread acceptance in otorhinolaryngology for its applications in sinus and skull base surgery. Although the core concepts of IGS have not changed, advances in image guidance technology, including the incorporation of intraoperative imaging, have the potential to enhance surgical education, allow for more rigorous preoperative planning, and aid in more complete surgery with improved outcomes. OBJECTIVES Provide a clinical update regarding the use of image guidance and intraoperative imaging in the field of rhinology and endoscopic skull base surgery with a focus on current state of the art technologies. METHODS English-language studies published in PubMed, Cochrane, and Embase were searched for articles relating to image-guided sinus surgery, skull base surgery, and intraoperative imaging. Relevant studies were reviewed and critical appraisals were included in this clinical update, highlighting current state of the art advances. CONCLUSIONS As image guidance and intraoperative imaging systems have advanced, their applications in sinus and skull base surgery have expanded. Both technologies offer invaluable real-time feedback on the status and progress of surgery, and thus may help to improve the completeness of surgery and overall outcomes. Recent advances such as augmented and virtual reality offer a window into the future of IGS. Future advancements should aim to enhance the surgeon's operative experience by improving user satisfaction and ultimately lead to better surgical results.
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Affiliation(s)
- Isaac L Schmale
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - Laura J Vandelaar
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
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Video-based augmented reality combining CT-scan and instrument position data to microscope view in middle ear surgery. Sci Rep 2020; 10:6767. [PMID: 32317726 PMCID: PMC7174368 DOI: 10.1038/s41598-020-63839-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022] Open
Abstract
The aim of the study was to develop and assess the performance of a video-based augmented reality system, combining preoperative computed tomography (CT) and real-time microscopic video, as the first crucial step to keyhole middle ear procedures through a tympanic membrane puncture. Six different artificial human temporal bones were included in this prospective study. Six stainless steel fiducial markers were glued on the periphery of the eardrum, and a high-resolution CT-scan of the temporal bone was obtained. Virtual endoscopy of the middle ear based on this CT-scan was conducted on Osirix software. Virtual endoscopy image was registered to the microscope-based video of the intact tympanic membrane based on fiducial markers and a homography transformation was applied during microscope movements. These movements were tracked using Speeded-Up Robust Features (SURF) method. Simultaneously, a micro-surgical instrument was identified and tracked using a Kalman filter. The 3D position of the instrument was extracted by solving a three-point perspective framework. For evaluation, the instrument was introduced through the tympanic membrane and ink droplets were injected on three middle ear structures. An average initial registration accuracy of 0.21 ± 0.10 mm (n = 3) was achieved with a slow propagation error during tracking (0.04 ± 0.07 mm). The estimated surgical instrument tip position error was 0.33 ± 0.22 mm. The target structures’ localization accuracy was 0.52 ± 0.15 mm. The submillimetric accuracy of our system without tracker is compatible with ear surgery.
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Fusion of augmented reality imaging with the endoscopic view for endonasal skull base surgery; a novel application for surgical navigation based on intraoperative cone beam computed tomography and optical tracking. PLoS One 2020; 15:e0227312. [PMID: 31945082 PMCID: PMC6964902 DOI: 10.1371/journal.pone.0227312] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 12/16/2019] [Indexed: 01/11/2023] Open
Abstract
Objective Surgical navigation is a well-established tool in endoscopic skull base surgery. However, navigational and endoscopic views are usually displayed on separate monitors, forcing the surgeon to focus on one or the other. Aiming to provide real-time integration of endoscopic and diagnostic imaging information, we present a new navigation technique based on augmented reality with fusion of intraoperative cone beam computed tomography (CBCT) on the endoscopic view. The aim of this study was to evaluate the accuracy of the method. Material and methods An augmented reality surgical navigation system (ARSN) with 3D CBCT capability was used. The navigation system incorporates an optical tracking system (OTS) with four video cameras embedded in the flat detector of the motorized C-arm. Intra-operative CBCT images were fused with the view of the surgical field obtained by the endoscope’s camera. Accuracy of CBCT image co-registration was tested using a custom-made grid with incorporated 3D spheres. Results Co-registration of the CBCT image on the endoscopic view was performed. Accuracy of the overlay, measured as mean target registration error (TRE), was 0.55 mm with a standard deviation of 0.24 mm and with a median value of 0.51mm and interquartile range of 0.39˗˗0.68 mm. Conclusion We present a novel augmented reality surgical navigation system, with fusion of intraoperative CBCT on the endoscopic view. The system shows sub-millimeter accuracy.
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Zeiger J, Costa A, Bederson J, Shrivastava RK, Iloreta AMC. Use of Mixed Reality Visualization in Endoscopic Endonasal Skull Base Surgery. Oper Neurosurg (Hagerstown) 2019; 19:43-52. [DOI: 10.1093/ons/opz355] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 09/13/2019] [Indexed: 12/28/2022] Open
Abstract
Abstract
BACKGROUND
Neuronavigation systems assist with spatial orientation during endoscopic transnasal skull base surgery, but they require a correlation of 3-dimensional (3D) views with 2-dimensional (2D) radiology studies.
OBJECTIVE
To outline an initial experience with a novel technology platform that provides intraoperative navigation using 3D reconstructions of patient anatomy for endoscopic surgery.
METHODS
A retrospective study of endoscopic anterior skull base and complex paranasal procedures was performed. Data from preoperative computed tomography and magnetic resonance imaging scans were fused to create 3D digital models of patient anatomy. Using the technology developed by Surgical Theater (Mayfield Village, Ohio), these reconstructions were designed to highlight particular anatomic regions of interest. The models were studied to guide the surgical approach and anticipate critical structures.
The reconstructions were linked with the navigational technology created by Brainlab (Munich, Germany) during endoscopic surgery. A dynamic image of the reconstruction was displayed alongside a matching endoscopic camera view. These 2 views could be overlaid to provide an immersive, mixed reality image of the patient's anatomy.
RESULTS
A total of 134 cases were performed. The pathologies included tumors of the anterior skull base or sinonasal cavity, inflammatory sinus disease, and cerebrospinal fluid leaks. Specific anatomic structures, such as the internal carotid arteries and optic nerves, were chosen for enhancement. Surgeons felt that the technology helped to guide the extent of bony dissection and to identify critical structures.
CONCLUSION
We describe the first clinical series of complex skull base pathologies treated using a novel mixed reality platform.
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Affiliation(s)
- Joshua Zeiger
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anthony Costa
- Icahn School of Medicine at Mount Sinai, New York, New York
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Casale M, Costantino A, Sabatino L, Cassano M, Moffa A, Rinaldi V. Image-guided endoscopic marsupialization technique for frontal sinus mucocele with orbital extension: A case report. Int J Surg Case Rep 2019; 61:259-262. [PMID: 31398667 PMCID: PMC6698318 DOI: 10.1016/j.ijscr.2019.07.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 11/22/2022] Open
Abstract
Navigated assisted ESS is a safe treatment for FM with orbital extension. A navigation support could avoid an external approach. The image-guided system could be useful if bony landmarks are missing. The image-guided system could be useful if orbital erosion is present. Navigated assisted ESS could completely drain lateral and multi-cystic lesions.
Introduction Frontal sinus mucocele with intra-orbital extension represents a rare benign cyst-like lesion. Surgical management could be summarized in an open approach, an endoscopic marsupialization or a combined procedure. The present study reports a case of frontal mucocele with wide intra-orbital invasion treated with endoscopic marsupialization assisted by an image-guided navigation system. Presentation of case A 34-year-old African male was referred to the otolaryngology clinic for unilateral supraorbital swelling and post-nasal drip. A clinical ophthalmic assessment showed normal ocular movement, the absence of diplopia and normal visual acuity. CT scan showed a large soft tissue density lesion originating from the right frontal sinus with a supero-medial orbital erosion. The mass invaded the orbital cavity compressing and dislocating the eyeball forward and laterally. An image-guided ESS was performed according to Draft type IIa. Frontal mucocele’s inferior wall was open in order to drain muco-purulent content. No complications were detected and the patient was completely recovered with open frontal sinus drainage at 4 months follow-up visit. Discussion We have successfully treated a wide intra-orbital frontal mucocele with an endoscopic marsupialization thanks to image-guided navigation system support. This technology prevented an external approach with associated morbidity and longer hospitalization. Conclusion Navigated assisted endoscopic approach with marsupialization can be considered a safe treatment for FM with orbital extension. In particular, the image-guided system could be useful if bony landmarks are missing, if orbital erosion is present, and to completely drain lateral and multi-cystic lesions.
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Affiliation(s)
- Manuele Casale
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, University Campus Bio-Medico, Rome, Italy.
| | - Andrea Costantino
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, University Campus Bio-Medico, Rome, Italy.
| | - Lorenzo Sabatino
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, University Campus Bio-Medico, Rome, Italy.
| | - Michele Cassano
- Department of Otolaryngology, University of Foggia, Foggia, Italy.
| | - Antonio Moffa
- Department of Otolaryngology, University of Foggia, Foggia, Italy.
| | - Vittorio Rinaldi
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, University Campus Bio-Medico, Rome, Italy.
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Hussain R, Lalande A, Guigou C, Bozorg Grayeli A. Contribution of Augmented Reality to Minimally Invasive Computer-Assisted Cranial Base Surgery. IEEE J Biomed Health Inform 2019; 24:2093-2106. [DOI: 10.1109/jbhi.2019.2954003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Zagzoog N, Yang VXD. State of Robotic Mastoidectomy: Literature Review. World Neurosurg 2018; 116:347-351. [PMID: 29870847 DOI: 10.1016/j.wneu.2018.05.194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
Abstract
Over the past 30 years, the application of robotics in the field of neurotology has grown. Robots are able to perform increasingly complex tasks with ever improving accuracy, allowing them to be used in a broad array of applications. A mastoidectomy, in which a drill is used to remove a portion of the mastoid part of the temporal bone at the base of the skull, is one such application. To determine the current state of neurotologic robotics in the specific context of mastoidectomy, a review of the literature was carried out. This qualitative review explores what has been done in this field to date, as well as what has yet to be done. Although the research suggests that robotics can be and has been successfully used to assist with mastoidectomy, it also suggests the incompleteness of robotic development in the field. At present, only 2 robotic systems have been approved by the U.S. Food and Drug Administration for neurosurgical use and the literature lacks evidence of meaningful clinical testing of new systems to change that. The cost of robotics also remains prohibitive. However, strides have been made, with at least 1 robot for mastoidectomy having reached the point of cadaveric trials. In addition, the research suggests some of the characteristics that should be considered when designing robots for mastoidectomy, such as burr size and the type of forces that should be applied. Overall, the outlook for robots in neurotology, particularly mastoidectomy, is bright but some hurdles still remain to be overcome.
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Affiliation(s)
- Nirmeen Zagzoog
- Institute of Medical Science, School of Graduate Studies, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Biophotonics and Bioengineering Laboratory, Ryerson University, Toronto, Ontario, Canada.
| | - Victor X D Yang
- Institute of Medical Science, School of Graduate Studies, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada; Biophotonics and Bioengineering Laboratory, Ryerson University, Toronto, Ontario, Canada; Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada
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