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Sharma A, Song R, Sarmey N, Harasimchuk S, Bulacio J, Pucci F, Rammo R, Bingaman W, Serletis D. Validation and Safety Profile of a Novel, Noninvasive Fiducial Attachment for Stereotactic Robotic-Guided Stereoelectroencephalography: A Case Series. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01137. [PMID: 38651866 DOI: 10.1227/ons.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES We developed, tested, and validated a novel, noninvasive, Leksell G frame-based fiducial attachment, for use in stereotactic registration for stereoelectroencephalography (sEEG). Use of the device increased the number of fixed reference points available for registration, while obviating the need for additional scalp incisions. We report here on our experience and safety profile of using the device. METHODS We collected registration data using the fiducial device across 25 adult and pediatric patients with epilepsy consecutively undergoing robotic-guided sEEG for invasive epilepsy monitoring, treated between May 2022 and July 2023. ROSA One Brain was used for trajectory planning and electrode implantation. Postoperative clinical and radiographic data were computed and quantified, including mean registration error for all patients. Entry point, target point (TP), and angular errors were measured. Descriptive statistics and correlation coefficients for error were calculated. RESULTS Twenty-five patients underwent robotic-guided sEEG implantation (11 patients, bilateral; 10 patients, left unilateral; 4 patients, right). The mean number of electrodes per patient was 18 ± 3. The average mean registration error was 0.77 ± 0.11 mm. All patients were implanted with Ad-Tech depth electrodes. No clinically relevant complications were reported. Analysis of trajectory error was performed on 446 electrodes. The median entry point error was 1.03 mm (IQR 0.69-1.54). The median TP error was 2.26 mm (IQR 1.63-2.93). The mean angular error was 0.03 radians (IQR 0.02-0.05). There was no significant correlation between root mean square error and lead error. Root mean square error did not appreciably change over time, nor were there any significant changes in average angular, entry point, or TP error metrics. CONCLUSION A novel, noninvasive, Leksell G frame-based fiducial attachment was developed, tested, and validated, facilitating O-arm-based stereotactic registration for sEEG. This simple innovation maintained an excellent accuracy and safety profile for sEEG procedures in epilepsy patients, with the added advantages of providing additional reference points for stereotactic registration, without requiring additional scalp incisions.
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Affiliation(s)
- Akshay Sharma
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ryan Song
- Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Nehaw Sarmey
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen Harasimchuk
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Juan Bulacio
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francesco Pucci
- Department of Neurosurgery, University of Illinois, Chicago, Chicago, Illinois, USA
| | - Richard Rammo
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - William Bingaman
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Demitre Serletis
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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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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Taleb A, Guigou C, Leclerc S, Lalande A, Bozorg Grayeli A. Image-to-Patient Registration in Computer-Assisted Surgery of Head and Neck: State-of-the-Art, Perspectives, and Challenges. J Clin Med 2023; 12:5398. [PMID: 37629441 PMCID: PMC10455300 DOI: 10.3390/jcm12165398] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Today, image-guided systems play a significant role in improving the outcome of diagnostic and therapeutic interventions. They provide crucial anatomical information during the procedure to decrease the size and the extent of the approach, to reduce intraoperative complications, and to increase accuracy, repeatability, and safety. Image-to-patient registration is the first step in image-guided procedures. It establishes a correspondence between the patient's preoperative imaging and the intraoperative data. When it comes to the head-and-neck region, the presence of many sensitive structures such as the central nervous system or the neurosensory organs requires a millimetric precision. This review allows evaluating the characteristics and the performances of different registration methods in the head-and-neck region used in the operation room from the perspectives of accuracy, invasiveness, and processing times. Our work led to the conclusion that invasive marker-based methods are still considered as the gold standard of image-to-patient registration. The surface-based methods are recommended for faster procedures and applied on the surface tissues especially around the eyes. In the near future, computer vision technology is expected to enhance these systems by reducing human errors and cognitive load in the operating room.
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Affiliation(s)
- Ali Taleb
- Team IFTIM, Institute of Molecular Chemistry of University of Burgundy (ICMUB UMR CNRS 6302), Univ. Bourgogne Franche-Comté, 21000 Dijon, France; (C.G.); (S.L.); (A.L.); (A.B.G.)
| | - Caroline Guigou
- Team IFTIM, Institute of Molecular Chemistry of University of Burgundy (ICMUB UMR CNRS 6302), Univ. Bourgogne Franche-Comté, 21000 Dijon, France; (C.G.); (S.L.); (A.L.); (A.B.G.)
- Otolaryngology Department, University Hospital of Dijon, 21000 Dijon, France
| | - Sarah Leclerc
- Team IFTIM, Institute of Molecular Chemistry of University of Burgundy (ICMUB UMR CNRS 6302), Univ. Bourgogne Franche-Comté, 21000 Dijon, France; (C.G.); (S.L.); (A.L.); (A.B.G.)
| | - Alain Lalande
- Team IFTIM, Institute of Molecular Chemistry of University of Burgundy (ICMUB UMR CNRS 6302), Univ. Bourgogne Franche-Comté, 21000 Dijon, France; (C.G.); (S.L.); (A.L.); (A.B.G.)
- Medical Imaging Department, University Hospital of Dijon, 21000 Dijon, France
| | - Alexis Bozorg Grayeli
- Team IFTIM, Institute of Molecular Chemistry of University of Burgundy (ICMUB UMR CNRS 6302), Univ. Bourgogne Franche-Comté, 21000 Dijon, France; (C.G.); (S.L.); (A.L.); (A.B.G.)
- Otolaryngology Department, University Hospital of Dijon, 21000 Dijon, France
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Pionteck A, Pierrat B, Gorges S, Albertini JN, Avril S. Evaluation and Verification of Fast Computational Simulations of Stent-Graft Deployment in Endovascular Aneurysmal Repair. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:704806. [PMID: 35047943 PMCID: PMC8757824 DOI: 10.3389/fmedt.2021.704806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/28/2021] [Indexed: 11/22/2022] Open
Abstract
Fenestrated Endovascular Aortic Repair, also known as FEVAR, is a minimally invasive procedure that allows surgeons to repair the aorta while still preserving blood flow to kidneys and other critical organs. Given the high complexity of FEVAR, there is a pressing need to develop numerical tools that can assist practitioners at the preoperative planning stage and during the intervention. The aim of the present study is to introduce and to assess an assistance solution named Fast Method for Virtual Stent-graft Deployment for computer assisted FEVAR. This solution, which relies on virtual reality, is based on a single intraoperative X-ray image. It is a hybrid method that includes the use of intraoperative images and a simplified mechanical model based on corotational beam elements. The method was verified on a phantom and validated on three clinical cases, including a case with fenestrations. More specifically, we quantified the errors induced by the different simplifications of the mechanical model, related to fabric simulation and aortic wall mechanical properties. Overall, all errors for both stent and fenestration positioning were less than 5 mm, making this method compatible with clinical expectations. More specifically, the errors related to fenestration positioning were less than 3 mm. Although requiring further validation with a higher number of test cases, our method could achieve an accuracy compatible with clinical specifications within limited calculation time, which is promising for future implementation in a clinical context.
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Affiliation(s)
- Aymeric Pionteck
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, France.,THALES, Microwave & Imaging Sub-Systems, Moirans, France
| | - Baptiste Pierrat
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, France
| | | | - Jean-Noël Albertini
- INSERM, U1059 Sainbiose and University Hospital of Saint-Etienne, Univ Jean Monnet, Saint-Etienne, France
| | - Stéphane Avril
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, France
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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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Frameless and Maskless Stereotactic Navigation with a Skull-Mounted Tracker. World Neurosurg 2017; 102:661-667. [PMID: 28300710 DOI: 10.1016/j.wneu.2017.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this series, we present 3 cases that show the use of a skull-mounted tracker for image-guided navigation for anterior skull base surgery and ventricular catheter placement procedures. This system obviates fiducials or face masks during the surgical procedure itself and allows for the performance of facial incisions using the Weber-Ferguson approach. METHODS Our series presents the use of a novel intraoperative navigational system that uses a skull-mounted tracker to navigated anterior skull base surgery. RESULTS We present 3 cases using this new system: 1 anterior skull base tumor removal that was operated on without a facemask for navigation and 2 ventricular catheter placement procedures. CONCLUSIONS Intraoperative image-guided navigation has revolutionized neurosurgery. It undoubtedly increases the surgeon's confidence and the perception of safety. Although fiducials and facial masks are the most widely used tools for intraoperative navigation, their use is associated with certain complications. This technique permits free movement of the head during surgery, which in turn facilitates the exposure of head and neck lesions and expedites the approach to ventricular catheter placement. Our case series shows the precision and ease of our technique, which is less time consuming and less cumbersome than the traditional frame-based stereotaxy. In addition, the skull-mounted tracker system allows improved anatomic localization and shorter operating time and avoids the complications associated with the use of rigid fixating head frames.
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Li L, Yang J, Chu Y, Wu W, Xue J, Liang P, Chen L. A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study. PLoS One 2016; 11:e0146996. [PMID: 26757365 PMCID: PMC4710572 DOI: 10.1371/journal.pone.0146996] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/25/2015] [Indexed: 12/04/2022] Open
Abstract
Objective To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery. Materials and Methods In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems. Results The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons. Conclusion The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon’s skills and knowledge, not as a substitute.
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Affiliation(s)
- Liang Li
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jian Yang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing, China
| | - Yakui Chu
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing, China
| | - Wenbo Wu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jin Xue
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Lei Chen
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- * E-mail:
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Endoscopic Transseptal Approach to Frontal Sinus Disease. Indian J Otolaryngol Head Neck Surg 2015; 67:287-91. [PMID: 26405666 DOI: 10.1007/s12070-015-0879-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 06/24/2015] [Indexed: 10/23/2022] Open
Abstract
This paper describes an endoscopic transseptal approach to identify and access the frontal sinus and reviews the clinical cases. Between May 2004 and July 2010, endoscopic modified Lothrop procedure (EMLP) with transseptal approach was performed on sixteen patients. The indications for EMLP were complicated frontal sinusitis or cyst, revision surgery for failed frontal sinusotomy or Lynch procedure, or trauma cases. The first step of this procedure was to open a window in the bilateral anterior portion of the middle turbinates and nasal septum. The nasal septum, which could be observed through the window, should be the landmark of the midline during the surgery. A drill bur was raised up just behind the nasal bone along the midline of the nose. After the bilateral frontal sinuses and their posterior walls were confirmed, the interfrontal septum was removed superiorly. We reviewed the clinical records of patients who underwent the EMLP with transseptal approach. We have managed sixteen patients in this fashion. Neither intracranial nor orbital complications were encountered during or after surgery. Endoscopic transseptal frontal sinus surgery is simple to perform, and does not cause severe complications.
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Dhaliwal PP, Hurlbert RJ, Sutherland GS. Intraoperative Magnetic Resonance Imaging and Neuronavigation for Transoral Approaches to Upper Cervical Pathology. World Neurosurg 2012; 78:164-9. [DOI: 10.1016/j.wneu.2011.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 07/28/2011] [Accepted: 09/04/2011] [Indexed: 10/15/2022]
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de Lara D, Ditzel Filho LFS, Prevedello DM, Otto BA, Carrau RL. Application of image guidance in pituitary surgery. Surg Neurol Int 2012; 3:S73-8. [PMID: 22826819 PMCID: PMC3400488 DOI: 10.4103/2152-7806.95418] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 03/22/2012] [Indexed: 11/17/2022] Open
Abstract
Background: Surgical treatment of pituitary pathologies has evolved along the years, adding safety and decreasing morbidity related to the procedure. Advances in the field of radiology, coupled with stereotactic technology and computer modeling, have culminated in the contemporary and widespread use of image guidance systems, as we know them today. Image guidance navigation has become a frequently used technology that provides continuous three-dimensional information for the accurate performance of neurosurgical procedures. We present a discussion about the application of image guidance in pituitary surgeries. Methods: Major indications for image guidance neuronavigation application in pituitary surgery are presented and demonstrated with illustrative cases. Limitations of this technology are also presented. Results: Patients presenting a history of previous transsphenoidal surgeries, anatomical variances of the sphenoid sinus, tumors with a close relation to the internal carotid arteries, and extrasellar tumors are the most important indications for image guidance in pituitary surgeries. The high cost of the equipment, increased time of surgery due to setup time, and registration and the need of specific training for the operating room personnel could be pointed as limitations of this technology. Conclusion: Intraoperative image guidance systems provide real-time images, increasing surgical accuracy and enabling safe, minimally invasive interventions. However, the use of intraoperative navigation is not a replacement for surgical experience and a systematic knowledge of regional anatomy. It must be recognized as a tool by which the neurosurgeon can reduce the risk associated with surgical approach and treatment of pituitary pathologies.
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Affiliation(s)
- Danielle de Lara
- Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
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Sieśkiewicz A, Łysoń T, Mariak Z, Rogowski M. [Neuronavigation in transnasal endoscopic paranasal sinuses and cranial base surgery: comparison of the optical and electromagnetic systems]. Otolaryngol Pol 2009; 63:256-60. [PMID: 19886532 DOI: 10.1016/s0030-6657(09)70118-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Transnasal endoscopic operative methods became increasingly popular in paranasal sinuses and cranial base surgery. Various types of localization systems are recently used to navigate through and between tangled anatomical structures in this region. The aim of this study was to compare (as basing on our own clinical experience), the advantages and limitations of the optical and electromagnetic neuronavigation systems. MATERIAL AND METHOD Optical neuronavigation system (Stealth Station Treon plus, Medtronic, U.S.A.) and electromagnetic neuronavigation systems (DigiPointeur, Collin, France and Fusion ENT, Medtronic, USA) were used during endoscopic operations of paranasal sinuses, anterior skull base, orbits, parasellar region and clivus. The subject of comparison were precision of both system types and additional time necessary for setting up the system. Also assessed were convenience of navigation and easiness of manipulation with neuronavigated instruments during surgical procedures performed using classical endoscopic technique, bimanual technique and four hand technique. RESULTS The accuracy was high and comparable for both system types and did not deteriorate during the procedure. The time needed to set up of the optical system was somewhat longer. Surgeon's comfort during operative procedures was assessed as slightly higher for the electromagnetic systems, especially if four hand or bimanual techniques were used and if constant neuronavigation was indispensible. The optical system allows for navigation of a variety of surgical tools and this was considered a great advantage over the electromagnetic systems in this particular application. CONCLUSIONS The additional time spent in the operative theatre for getting a system ready is well paid off by better orientation of a surgeon in the operative field consequently increasing safety and higher accuracy of surgical procedure. What system should a surgeon use depends to a great extent on the type of planed procedure and preferred surgical technique.
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Widmann G, Stoffner R, Bale R. Errors and error management in image-guided craniomaxillofacial surgery. ACTA ACUST UNITED AC 2009; 107:701-15. [DOI: 10.1016/j.tripleo.2009.02.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 02/05/2009] [Accepted: 02/05/2009] [Indexed: 12/15/2022]
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Kainuma K, Netsu K, Asamura K, Hayashi K, Takumi Y, Ota H, Usami SI. Chondrosarcoma of the nasal septum: A case report. Auris Nasus Larynx 2009; 36:601-5. [PMID: 19282118 DOI: 10.1016/j.anl.2008.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 12/05/2008] [Accepted: 12/19/2008] [Indexed: 11/29/2022]
Abstract
Chondrosarcoma make up only 10-20% of malignant primary bone tumors, with 5-10% located in the head and neck (Downey TJ, Clark SK, Moore DW. Chondrosarcoma of the nasal septum. Otolaryngol Head Neck Surg 2001;125:98-100), and nasal septal chondrosarcoma is extremely rare. Surgical excision is the only curative treatment and radiation and chemotherapy have a limited role for palliation. We used a navigation system in endoscopic surgery without complications for a case of chondrosarcoma of the nasal septum by means of a midfacial degloving approach at primary operation and an external incision approach at salvage operation for local recurrence. To our knowledge, this is the first report of the use of such a system for this surgical approach along with a salvage operation. We discuss the clinical presentation, diagnosis, and treatment of this case as well as present a review of the literature.
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Affiliation(s)
- Kazuyuki Kainuma
- Department of Otolaryngology, Shinshu University School of Medicine, Asahi, Matsumoto, Japan.
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14
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Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM. Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 2008; 108:715-28. [DOI: 10.3171/jns/2008/108/4/0715] [Citation(s) in RCA: 270] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Craniopharyngiomas are notoriously difficult to treat. Surgeons must weigh the risks of aggressive resection against the long-term challenges of recurrence. Because of their parasellar location, often extending well beyond the sella, these tumors challenge vision and pituitary and hypothalamic function. New techniques are needed to improve outcomes in patients with these tumors while decreasing treatment morbidity. An endoscopic expanded endonasal approach (EEA) is one such technique that warrants understanding and evaluation. The authors explain the techniques and approach used for the endoscopic endonasal resection of suprasellar craniopharyngiomas and introduce a tumor classification scheme.
Methods
The techniques and approach used for the endoscopic, endonasal resection of suprasellar craniopharyngiomas is explained, including the introduction of a tumor classification scheme. This scheme is helpful for understanding both the appropriate expanded approach as well as relevant involved anatomy.
Results
The classification scheme divides tumors according to their suprasellar extension: Type I is preinfundibular; Type II is transinfundibular (extending into the stalk); Type III is retroinfundibular, extending behind the gland and stalk, and has 2 subdivisions (IIIa, extending into the third ventricle; and IIIb, extending into the interpeduncular cistern); and Type IV is isolated to the third ventricle and/or optic recess and is not accessible via an endonasal approach.
Conclusions
The endoscopic EEA requires a thorough understanding of both sinus and skull base anatomy. Moreover, in its application for craniopharyngiomas, an understanding of tumor growth and extension with respect to the optic chiasm and infundibulum is critical to safely approach the lesion via an endonasal route.
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Affiliation(s)
- Amin B. Kassam
- 1Minimally Invasive endoNeurosurgery Center,
- 2Center for Cranial Base Surgery,
- 3Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 4Department of Neurological Surgery; and
| | - Paul A. Gardner
- 1Minimally Invasive endoNeurosurgery Center,
- 4Department of Neurological Surgery; and
| | - Carl H. Snyderman
- 1Minimally Invasive endoNeurosurgery Center,
- 2Center for Cranial Base Surgery,
- 3Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 4Department of Neurological Surgery; and
| | - Ricardo L. Carrau
- 1Minimally Invasive endoNeurosurgery Center,
- 2Center for Cranial Base Surgery,
- 3Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 4Department of Neurological Surgery; and
| | - Arlan H. Mintz
- 1Minimally Invasive endoNeurosurgery Center,
- 4Department of Neurological Surgery; and
| | - Daniel M. Prevedello
- 1Minimally Invasive endoNeurosurgery Center,
- 4Department of Neurological Surgery; and
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15
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Sra J. Cardiac image integration implications for atrial fibrillation ablation. J Interv Card Electrophysiol 2008; 22:145-54. [PMID: 18363089 DOI: 10.1007/s10840-007-9199-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 12/21/2007] [Indexed: 12/14/2022]
Abstract
Cardiac image registration using computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and fluoroscopy is currently being investigated and clinically used for atrial fibrillation (AF) ablation. Cardiac image registration, in the context of left atrium, is intermodal, with the acquired image and the real-time reference image residing in different image spaces, and involves optimization, where one image space is transformed into the other. Geometry-based methods, which include using fiducial points and/or surface-based techniques, are usually used for cardiac image registration. During fiducial point registration, fiducial points are either external skin markers or manually determined by marking anatomical landmarks, using mapping catheters. Usually, a minimum of three non collinear points are needed for optimal registration. Recently, a catheter placed inside the coronary sinus has also been used as a fiducial marker for the purpose of registration. During surface registration, the process involves characterizing surfaces in each of the images and deriving the best transformation between them. Unlike rigid body registration, such as has been extensively used in imaging the brain, cardiac image registration is unique and challenging. In addition to the errors inherent in intermodal registration, such as errors in pixel and voxel dimension and errors due to fiducial point selection, there are errors specific to cardiac image registration, i.e., errors due to cardiac motion during the cardiac cycle and due to respiration. This review addresses the basic principles of registration and the inherent registration errors as they relate to cardiac imaging and registration.
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Affiliation(s)
- Jasbir Sra
- Electrophysiology Laboratories, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health-Milwaukee Clinical Campus, 2801 W. Kinnickinnic River Pkwy 777, Milwaukee, WI, 53215, USA,
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16
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Leventhal D, Heffelfinger R, Rosen M. Using image guidance tracking during balloon catheter dilation of sinus ostia. Otolaryngol Head Neck Surg 2007; 137:341-2. [PMID: 17666268 DOI: 10.1016/j.otohns.2007.04.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 04/24/2007] [Accepted: 04/30/2007] [Indexed: 11/19/2022]
Affiliation(s)
- Douglas Leventhal
- Department of Otolaryngology--Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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17
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Zimmer LA, Hirsch BE, Kassam A, Horowitz M, Snyderman CH. Resection of a recurrent paraganglioma via an endoscopic transnasal approach to the jugular fossa. Otol Neurotol 2007; 27:398-402. [PMID: 16639280 DOI: 10.1097/00129492-200604000-00017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To present a novel endoscopic, transnasal approach to a recurrent paraganglioma of the jugular fossa (glomus jugulare). STUDY DESIGN Case report and review of the literature. SETTING The study was carried out at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A. PATIENT A 64-year-old woman presented to the University of Pittsburgh Medical Center with a 9-month history of left otalgia, occasional vertigo, facial pain, and recurrent epistaxis. She had undergone two previous procedures over the past 35 years for a glomus tympanicum. Physical examination revealed a mass in the left nasopharynx originating from the eustachian tube. A computed tomographic scan revealed an expansive mass in the left jugular foramen extending into the posterior parapharyngeal space suggestive of a large jugular paraganglioma. INTERVENTION The patient underwent preoperative embolization of the paraganglioma. An endoscopic, transnasal approach along the eustachian tube, the ascending parapharyngeal carotid artery, and into the jugular fossa was used to remove the tumor. Intraoperative image guidance assisted in the identification of key anatomic landmarks. RESULTS Postoperative magnetic resonance imaging revealed a thin rim of enhancement at the posterior aspect of the jugular fossa consistent with residual tumor. The patient was discharged to home on postoperative Day 1 in stable condition. There have been no complications with 4 months of follow-up, and the left facial paralysis secondary to preoperative embolization has resolved. CONCLUSION We report the successful subtotal resection of a recurrent paraganglioma via a novel endoscopic, transnasal, transclival, transpetrous approach with image guidance. This approach allowed the near-total resection of a recurrent glomus jugulare with minimal surgical morbidity. Technological advances and surgical experience with nasal endoscopy and image guidance allow minimally invasive surgical management of select extracranial lesions of the lateral cranial base.
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Affiliation(s)
- Lee A Zimmer
- Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2546, USA
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18
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Citardi MJ, Batra PS. Intraoperative surgical navigation for endoscopic sinus surgery: rationale and indications. Curr Opin Otolaryngol Head Neck Surg 2007; 15:23-7. [PMID: 17211179 DOI: 10.1097/moo.0b013e3280123130] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The present review discusses the rationale and indications for image-guided surgery through a critical discussion of registration concepts as well as clinical reports. RECENT FINDINGS The surgical navigation accuracy achieved by commercially available image-guided surgery systems is best reported as target registration error. Clinically achievable target registration error is probably in the 1.5-2.0 mm range. Dry lab studies of registration serve to highlight the principles of registration, the process through which image-guided surgery systems calculate the one-to-one mapping relationship between the preoperative imaging data and the intraoperative surgical volume. Reports on image-guided surgery have highlighted its usefulness in primary and revision endoscopic sinus surgery, osteoplastic frontal sinusotomy, transsphenoidal hypophysectomy, endoscopic cerebrospinal fluid leak repair and endoscopic pterygomaxillary fossa biopsy. Both three-dimensional computed tomography angiography and computed tomography-magnetic resonance fusion images have been incorporated into IGS for advanced minimally invasive endoscopic skull base procedures. The American Academy of Otolaryngology-Head and Neck Surgery policy statement accurately summarizes the current consensus for image-guided surgery applications. SUMMARY Image-guided surgery has emerged as an important technology, which both general otolaryngologists and subspecialty rhinologists can employ for a wide variety of procedures.
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Affiliation(s)
- Martin J Citardi
- Section of Nasal and Sinus Disorders, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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19
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Abstract
To date, clinical application of image-guided surgery (IGS) to otology/neurotology has been limited, but a large potential market and numerous applications support use. Such applications include control of surgical instruments (eg, turning off a drill when close to an anatomic boundary), robotic surgery (eg, robotic mastoidectomy), and minimally invasive surgery (eg, percutaneous cochlear implantation).
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Affiliation(s)
- Robert F Labadie
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 7209 Medical Center East, South Tower, 1215 21(st) Avenue South, Nashville, TN 37232, USA.
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20
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Kassam AB, Thomas AJ, Zimmer LA, Snyderman CH, Carrau RL, Mintz A, Horowitz M. Expanded endonasal approach: a fully endoscopic completely transnasal resection of a skull base arteriovenous malformation. Childs Nerv Syst 2007; 23:491-8. [PMID: 17226032 DOI: 10.1007/s00381-006-0288-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE AND IMPORTANCE Vascular lesions with an intraosseus nidus involving the skull base are uncommon and challenging [Gianoli GJ, Amedee RG Vascular malformation of the sphenoid sinus. Ear Nose Throat J. 70:373-375;(1991), Malik GM, Mahmood A, Mehta BA Dural arteriovenous malformation of the skull base with intraosseous vascular nidus. Report of two cases. J. Neurosurg 81:620-623;(1994)]. We present a pediatric patient, with a life-threatening arteriovenous malformation (AVM) of the sphenoid sinus, clivus, and ventral skull base, who failed routine multimodality management of AVMs. An entirely transsphenoidal fully endoscopic resection was used to resect this ventral cranial base AVM with an intraosseus nidus located in the clivus. CLINICAL PRESENTATION A 4-year-old female presented with recurrent, life-threatening hemorrhages from a clival and ventral skull base AVM of the entire clivus and ventral skull base. The patient had been temporized from the age of 2-4 years with multiple internal and external carotid arterial particulate and alcohol embolizations, including both external and internal carotid artery embolizations, intracranial ligation of the right internal carotid artery, and gamma knife irradiation. Despite these multiple interventions, the patient had persistent, life-threatening hemorrhages from arterial recanalization and recruitment requiring intubation, tracheostomy, and nasopharyngeal packing. INTERVENTION The patient underwent a three-stage surgical intervention to resect the AVM. An open subfrontal approach, as the first procedure, provided minimal access to the feeding vessels and was therefore aborted. A two-stage image-guided fully endoscopic approach via a sublabial midface approach without external incisions was performed. Postoperative angiography revealed minimal residual shunting in the pharynx and cavernous sinus. The patient has been free of significant hemorrhages over the past three years. CONCLUSION Technological advances in endoscopic surgery and image guidance are now allowing for purely endoscopic surgical treatment of previously unresectable lesions with acceptable morbidity. We report the successful and safe resection of a ventral cranial base AVM via a fully endoscopic approach. This paper reports the first AVM with a purely intraosseus nidus of the ventral skull base and demonstrates the ability to deal with complex ventral skull base lesions using a fully endoscopic transsphenoidal technique.
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Affiliation(s)
- Amin B Kassam
- Department of Otolaryngology, University of Pittsburgh School of Medicine, UPMC Presbyterian University Hospital, Pittsburgh, PA 15213, USA.
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21
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Bartling SH, Leinung M, Graute J, Rodt T, Dullin C, Becker H, Lenarz T, Stover T, Majdani O. Increase of accuracy in intraoperative navigation through high-resolution flat-panel volume computed tomography: experimental comparison with multislice computed tomography-based navigation. Otol Neurotol 2007; 28:129-34. [PMID: 17195752 DOI: 10.1097/01.mao.0000244364.16826.09] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS High-resolution imaging, as provided by flat-panel-based volume computed tomography (fpVCT), could increase navigation accuracy and could therefore improve image-guided procedures or make novel navigated surgery concepts possible. BACKGROUND Intraoperative navigation is an accepted tool in head and neck surgery. However, its use is limited in the lateral cranial base because of its low surgical accuracy. Surgical accuracy is substantially influenced by the resolution of the underlying data set. The fpVCT offers a resolution of nearly two times higher than multislice computed tomography (MSCT). Target registration error (TRE), as a measurement for surgical navigation accuracy, should decrease when navigation is based on fpVCT data sets. METHODS An acrylic glass phantom with 37 fiducial points was scanned in a current MSCT and in an experimental fpVCT. Both data sets were imported in an optical navigation system. Five fiducial points were used for registration, and seven points were used for measuring TRE. The distance between the indicated pointer tip and the corresponding fiducial point in data set was measured as TRE. Registration and TRE measurement were repeated five times for each computed tomographic data set. Average TREs were calculated, and results were compared using t-test. RESULTS The average TRE using MSCT (0.82 mm [standard deviation, 0.35 mm]) was significantly higher than that using fpVCT (0.46 mm [standard deviation, 0.22 mm]) (p < 0.01). CONCLUSION Submillimeter surgical navigation accuracy is possible using high-resolution fpVCT. This could be highly beneficial in cranial base surgery navigation.
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Affiliation(s)
- Soenke H Bartling
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany.
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22
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Abstract
Imaging technology has played a significant role in the diagnosis and management of sinonasal disorders. Plain sinus films are almost exclusively replaced by CT in the work-up for inflammatory sinus disease. MRI provides complementary information to CT in cases of sinonasal and skull-base neoplasms. The evolution of endoscopic surgical techniques for the paranasal sinuses and skull base is made possible by the parallel advancement of imaging technologies. Recent advances that are currently in clinical use have included multidetector row CT scanners and computer image-guidance systems for surgery. Three-dimensional CT angiography, image-guided CT-MR fusion, and intraoperative image-guidance are new techniques that are currently being evaluated. As imaging technology continues to advance, so does the capability to treat diseases beyond the sinuses and skull base with minimally invasive, endoscopic approaches.
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Affiliation(s)
- Francis T K Ling
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, 1120 15th Street, Augusta, GA 30912, USA
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23
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Salas S, Brimacombe M, Schulder M. Stereotactic accuracy of a compact intraoperative MRI system. Stereotact Funct Neurosurg 2006; 85:69-74. [PMID: 17167234 DOI: 10.1159/000097921] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the stereotactic accuracy of the PoleStar N-20, a compact intraoperative magnetic resonance imaging (iMRI) system, based on a 0.15-Tesla (T) magnet. METHODS An MRI-compatible phantom was scanned after being positioned in both the center of the magnetic field (COF) and the periphery of the field (POF) of the PoleStar N-20 magnet. Scans were acquired at various slice thicknesses in 3 sequences: T(1) weighted, T(2) weighted and Esteady (reversed fast imaging with steady-state precession, also known as 'PSIF'). The distance between the actual location of the probe tip in space and the location of the target on the image was measured on the axial, coronal, and sagittal planes for 9 points on each image. Each measurement was repeated 3 times. We also compared the structural features of the PoleStar N-20 to those of its predecessor. RESULTS T(1)-weighted scans yielded the most accurate measurements. There was no statistically significant difference between scans acquired at thicknesses of 2, 3, 4 and 8 mm; all were accurate for clinical purposes. Comparison of COF with POF measurements using T(1)-weighted scans did not demonstrate a statistically significant difference in accuracy. CONCLUSIONS The PoleStar N-20 0.15-T iMRI system provides surgical navigation that is at least as accurate as the first generation model of this system, which employed a 0.12-T magnet. Further analysis of stereotactic accuracy on clinical cases using the PoleStar N-20 is needed to confirm that these results will bear out in surgical reality.
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Affiliation(s)
- Sussan Salas
- Department of Neurological Surgery, New Jersey Medical School, Newark, NJ 07103, USA
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24
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Knott PD, Batra PS, Butler RS, Citardi MJ. Contour and paired-point registration in a model for image-guided surgery. Laryngoscope 2006; 116:1877-81. [PMID: 17003709 DOI: 10.1097/01.mlg.0000234939.23796.7a] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study assesses target registration error (TRE) of contour-based registration (CBR) and paired-point registration (PPR) for endoscopic sinus surgery. STUDY DESIGN The experimental registration model consisted of a replica of a human head (Sawbones #1345-27; Pacific Research Laboratories, Vashon, WA). Twelve surface fiducial markers were affixed to the simulated skin on the model, and titanium screws were placed in the regions of the anterior ethmoid (AE) and sphenoid face (SF). An axial computed tomography scan (1-mm slice thickness) was then obtained. METHODS Registration was then performed on the InstaTrak 3500 Plus (GE Surgical Navigation & Visualization, Lawrence, MA) with the standard PPR protocol with 12 points and CBR protocol with 500, 250, 125, 50, and 4 points. TRE was then calculated at the AE and SF targets. RESULTS Target registration error was significantly lower for paired-point registration compared with contour-based registration (AE, 0.5 mm vs. 1.5 mm, P < .0001; SF, 0.8 mm vs. 1.5 mm, P < .0001). Among contour-based registration protocols, target registration error at the sphenoid face was lowest with 50 points (1.5 mm, P < .02). At the anterior ethmoid, contour-based registration with 50 points produced a lower target registration error than contour-based registration with 125 points (1.5 vs. 1.8 mm, P < .01). Other target registration error values for CBR were similar at both regions. The target registration error interquartile range was lowest with CBR-125 at both regions. CONCLUSIONS Paired-point registration provided significantly lower target registration error. Contour-based registration with 125 points (and possibly as few as 50 points) produces clinically acceptable target registration error. This registration model elucidates important concepts about registration for surgical navigation for sinus surgery.
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Affiliation(s)
- P Daniel Knott
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
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25
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Knott PD, Batra PS, Citardi MJ. Computer aided surgery: concepts and applications in rhinology. Otolaryngol Clin North Am 2006; 39:503-22, ix. [PMID: 16757228 DOI: 10.1016/j.otc.2006.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Computer-aided surgery (CAS) has become relevant in a growing number of disciplines. This article will describe the history and principals of CAS and explain some of the technical issues, applications, and outcomes for CAS in the domain of rhinology.
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Affiliation(s)
- P Daniel Knott
- The Cleveland Clinic Head and Neck Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Abstract
PURPOSE OF REVIEW Patients with advanced head and neck cancer are being treated with chemo-radiotherapy, and life is being prolonged, with or without persistent disease, for longer than was previously. Hypercalcaemia may present in patients with advanced or disseminated head and neck cancer, and, as such, these patients may present to a larger variety of clinicians for advice concerning their symptoms and illness. Modes of presentation of hypercalcaemia and treatment strategies are reviewed. RECENT FINDINGS There were previously few large series of head and neck cancer patients diagnosed with hypercalcaemia, which may or may not have been related to their cancer being treated. Investigations, by way of blood/serum calcium level, may identify such patients. Patients with cancer-related hypercalcaemia have a poor prognosis, but many may respond temporarily to treatment when offered, with an improvement of their quality of life and death. SUMMARY Hypercalcaemia should and must be considered in all patients who have or possibly have a diagnosis of a head and neck cancer and who present unwell with symptoms of fatigue, lethargy and somnolence. Investigation must include serum calcium (corrected for serum albumin binding) and parathyroid hormone level. Patients may be treated by a combination of rehydration and bisulphonate therapy until the serum calcium is reduced to a level below 3 mmol/l. The majority of patients diagnosed with hypercalcaemia due to head and neck malignancy die of their diseases in the short term, but some may enjoy a prolongation of life with reasonable quality if diagnosed and treated aggressively.
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Affiliation(s)
- Patrick J Bradley
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Nottingham, UK.
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27
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Kassam AB, Snyderman C, Gardner P, Carrau R, Spiro R. The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report. Neurosurgery 2006; 57:E213; discussion E213. [PMID: 15987596 DOI: 10.1227/01.neu.0000163687.64774.e4] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Accepted: 02/18/2005] [Indexed: 12/18/2022] Open
Abstract
The transoral approach to the odontoid process is considered the "gold standard" for resection of extradural lesions at this location. A completely transnasal endoscopic approach is feasible based on anatomic studies and our experience with the expanded endonasal approach for neoplasms of the cranial base. An illustrative case is presented to demonstrate the technical details of a fully transnasal completely endoscopic approach for the resection of the odontoid process. A 73-year-old woman with a long-standing history of rheumatoid arthritis presented with progressive cervicomedullary compression. Complete resection of the odontoid was achieved with no significant morbidity. This is the first reported case of a completely endoscopic resection of the odontoid using a fully transnasal route. The report demonstrates the feasibility of this approach and larger clinical series with long-term follow-up will be needed to determine the reproducibility and validation of any potential benefits.
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Affiliation(s)
- Amin B Kassam
- Department of Neurological Surgery, University of Pittsburgh and Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania 15213, USA.
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28
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Rafferty MA, Siewerdsen JH, Chan Y, Moseley DJ, Daly MJ, Jaffray DA, Irish JC. Investigation of C-arm cone-beam CT-guided surgery of the frontal recess. Laryngoscope 2006; 115:2138-43. [PMID: 16369157 DOI: 10.1097/01.mlg.0000180759.52082.45] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE/HYPOTHESIS A cone-beam CT (CBCT) imaging system based on a mobile C-arm (Siemens PowerMobil) incorporating a high-performance flat-panel detector (Varian PaxScan) has been developed in our laboratory. We hypothesize that intraoperative C-arm CBCT provides image quality and guidance performance sufficient to assist surgical approach to the frontal recess. STUDY DESIGN A preclinical prospective study was conducted using six cadaver heads to assess the performance characteristics and the potential clinical utility of this imaging system. METHODS The mobile C-arm was employed for intraoperative CBCT guidance of the endoscopic approach to twelve frontal recesses. RESULTS The imaging system is capable of sub-mm 3D spatial resolution with bone and soft-tissue visibility and a field of view sufficient for guidance of head and neck surgery. The system can generate intraoperative, volumetric CT images rapidly with an acceptably low radiation exposure to the patient and with image quality sufficient for most surgical tasks. Moreover, the system is portable and compatible with the surgical setup, providing excellent access to the patient. Finally, the accuracy of the system is not bound to a registration process. CONCLUSIONS The ability to create updated images as surgery progresses introduces the concept of 'near-real-time' CT guidance for head and neck surgery. We found that the use of CBCT increased surgical confidence in accessing the frontal recess, resolved ambiguities with anatomical variations, and provided valuable teaching information to surgeons in training in both preoperative planning and correlation between tri-planar CT scans and intraoperative endoscopic findings.
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Affiliation(s)
- M A Rafferty
- Department of Surgical Oncology, University Health Network, Toronto ON, Canada
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29
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Abstract
Endoscopic sinus surgery is one of the most common surgical procedures in otolaryngology. However, the location of the orbit and intracranial contents in close proximity to the paranasal sinuses makes endoscopic sinus surgery potentially hazardous. Otolaryngologists have employed computer-aided surgery, or image-guided surgery, over the past two decades to enhance surgeon confidence, allow more thorough surgical dissections and possibly reduce the complication rate of endoscopic sinus surgery. Computer-aided surgery utilizes preoperative imaging to provide real-time localization of surgical instruments in the surgical field. Although computer-aided surgery originated in the neurosurgical realm, otolaryngologists soon appreciated that this technology could assist in identifying critical orbital or intracranial structures surrounding the paranasal sinuses, and potentially aid in decreasing complications. In this article, the history of image-guidance systems and their application to surgery of the paranasal sinuses and skull base will be reviewed. The components of computer-aided surgery systems and the currently available technologies for surgical instrument tracking are discussed, as well as the advantages and disadvantages of each of the tracking technologies. In addition, issues relating to the accuracy of image-guidance systems are examined. A number of institutional series noting surgeon experience with computer-aided surgery in the domain of paranasal sinus surgery are reviewed. Furthermore, the authors evaluate the utility of image-guidance technology beyond the paranasal sinuses and skull base, such as its use in surgery of the pituitary gland and pterygopalatine fossa, research and resident education. Finally, potential future applications of computer-aided surgery technology are discussed.
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Affiliation(s)
- Sarah K Wise
- The Emory Clinic, Department of Otolaryngology-Head and Neck Surgery, Atlanta, GA 30322, USA
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Kassam A, Gardner P, Snyderman C, Carrau R, Zimmer L, Hirsch B, Mintz A. Endoscopic, Expanded Endonasal Approach to the Jugular Foramen. ACTA ACUST UNITED AC 2005. [DOI: 10.1053/j.otns.2005.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
PURPOSE OF REVIEW Use of image-guided surgery (IGS) systems in otolaryngology, particularly rhinology, has grown exponentially in recent years. Central to their use is the understanding of the accuracy of each system. The purpose of this review is to discuss the error inherent in all IGS systems. A standardized technique (currently used in the engineering literature) for understanding and reporting error in IGS systems is reviewed. Using this technique, the error of commercially available IGS systems is reviewed. RECENT FINDINGS The most commonly used IGS systems depend on the conformation of the skin, as opposed to relying on bone-implanted devices. For these systems, mean accuracies 2 mm or less are routinely reported. This finding is independent of fiducial markers (eg, proprietary headsets, skin-affixed markers, or laser scanning of skin surfaces). Techniques of fiducial localization and registration of CT scans to intraoperative anatomy are proprietary to each company. As such, there is great variability in reporting system specifications-particularly error of IGS systems. This lack of standardization makes comparison of one system to another difficult if not impossible. SUMMARY Image-guided surgery systems commonly used in rhinology report mean accuracies of 2 mm or less. Surgeons must be aware that this value represents a mean of a distribution of errors. As such, 95% of the time error can be expected to be less than approximately 1.7 times its mean value. However, outliers (errors much larger and much smaller than the mean) may exist for each IGS intervention. As noted, IGS systems function to complement-not replace-knowledge of surgical anatomy.
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Affiliation(s)
- Robert F Labadie
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2559, USA.
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