1
|
Schulze M, Hirt B, Reimann K. Flat panel CT versus multidetector CT in skull base imaging: are there differences in image quality? Head Face Med 2023; 19:50. [PMID: 37980498 PMCID: PMC10656997 DOI: 10.1186/s13005-023-00391-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/11/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Purpose of this study was to compare image quality of the skull base in standard 20s protocol flat panel computed tomography (FPCT) with the new time and dose improved 10s protocol as well as with 128 slice multidetector computed tomography (MDCT). METHODS 10 whole skull preparations were scanned with either 128 slice MDCT(SOMATOM Definition AS+, Siemens, Erlangen) or FPCT (AXIOM-Artis, Siemens, Erlangen) using 10s or 20s protocol. RESULTS FPCT provides significantly better image quality and improved delimitation of clinically relevant structures in the anterior, temporal and posterior skull base compared to 128 slice MDCT. The 20s FPCT protocol yielded best delimitability of evaluated skull base structures. However, the shorter, dose saving 10s FPCT protocol was still significantly superior to 128 slice MDCT regarding delimitability of skull base structures and additionally showed no significant inferiority compared with the 20s FPCT protocol. CONCLUSIONS The 10s FPCT protocol yields a significantly better image quality at a comparable radiation dose exposure in imaging skull base structures compared to MDCT. TRIAL REGISTRATION 371/2017BO2.
Collapse
Affiliation(s)
- Maximilian Schulze
- Department of Neuroradiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
- Department of Neuroradiology, University Hospital Marburg, Philipps University Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Elfriede-Aulhorn-Straße 8, 72076, Tübingen, Germany
| | - Katrin Reimann
- Department of Otolaryngology - Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Strasse 5, 72076, Tübingen, Germany
- Department of Otolaryngology - Head and Neck Surgery, Philipps-Universität Marburg, Baldingerstrasse, Marburg, 35043, Germany
| |
Collapse
|
2
|
Fawzy HH, Saber AF, Nassar AT, Eid KA, Ghareeb FM. Technical considerations of computer-aided planning in severe orbital trauma: A retrospective study. J Craniomaxillofac Surg 2022; 50:873-883. [PMID: 36681615 DOI: 10.1016/j.jcms.2023.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 11/11/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
The aim of this study was to evaluate the clinical outcomes of linear and orbital volume measurements in severe orbital trauma. Patients with severe orbital trauma that involved more than two walls and entailed a marked degree of comminution were included in this retrospective analysis. However, patients with incomplete clinical records and a simple blowout or zygmatico-orbital fractures were excluded. All the cases underwent surgical correction guided by virtual surgical planning and 3D-printed templates. The measurement protocol depended on assessing orbital dimensions, orbital volumetry, and the zygomatic bone's position in the three-dimensional planes. All patients' preoperative 3D CT scans were obtained, and DICOM files were imported into a three-dimensional image processing software. Data were then converted for 3D reconstruction in the axial, coronal, and sagittal views. A total of 18 patients with a mean age was 39.28 ± 6.28 were included in this study. The results revealed a significant difference between the pre and postoperative differences in distances in relation to the FHP (Frankfurt Horizontal Plane) (P = 0.0014) and sagittal planes (P < 0.0001). The orbital width and height of the traumatized orbit were significantly decreased from 45.26 ± 6.72 mm and 45.30 ± 2.89 mm to 39.74 ± 3.91 mm (P = 0.0022), and 40.34 ± 0.86 mm (P < 0.0001), respectively. Clinically, there was a satisfactory degree of symmetry regarding the zygomatic bones' position and orbital dimensions postoperatively. Moreover, the mean orbital volume on the traumatized side decreased significantly from 23.16 ± 1.91 cm3 preoperatively to 20.7 ± 1.96 cm3 postoperatively (P < 0.0001). These findings were associated with a low incidence of complications. Within the limitations of the study it seems that the described methodology is a relevant addition to clinical treatment options. It incorporates all the latest technology to plan virtual reconstruction surgery in the treatment of complex orbital trauma and should be adapted accordingly in cases of severe displacement and comminution.
Collapse
Affiliation(s)
- Hossam Hassan Fawzy
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
| | - Ahmed Fergany Saber
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed Tharwat Nassar
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - Fouad Mohamed Ghareeb
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| |
Collapse
|
3
|
Barber SR. New Navigation Approaches for Endoscopic Lateral Skull Base Surgery. Otolaryngol Clin North Am 2021; 54:175-187. [PMID: 33243374 DOI: 10.1016/j.otc.2020.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Image-guided navigation is well established for surgery of the brain and anterior skull base. Although navigation workstations have been used widely by neurosurgeons and rhinologists for decades, utilization in the lateral skull base (LSB) has been less due to stricter requirements for overall accuracy less than 1 mm in this region. Endoscopic approaches to the LSB facilitate minimally invasive surgeries with less morbidity, yet there are risks of injury to critical structures. With improvements in technology over the years, image-guided navigation for endoscopic LSB surgery can reduce operative time, optimize exposure for surgical corridors, and increase safety in difficult cases.
Collapse
Affiliation(s)
- Samuel R Barber
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, 1501 North Campbell Avenue, Tucson, AZ 85724, USA.
| |
Collapse
|
4
|
Taeger J, Müller-Graff FT, Neun T, Köping M, Schendzielorz P, Hagen R, Rak K. Highly precise navigation at the lateral skull base by the combination of flat-panel volume CT and electromagnetic navigation. Sci Prog 2021; 104:368504211032090. [PMID: 34397283 PMCID: PMC10450718 DOI: 10.1177/00368504211032090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to evaluate the feasibility and accuracy of electromagnetic navigation at the lateral skull base in combination with flat panel volume computed tomography (fpVCT) datasets. A mastoidectomy and a posterior tympanotomy were performed on 10 samples of fresh frozen temporal bones. For registration, four self-drilling titanium screws were applied as fiducial markers. Multi-slice computed tomography (MSCT; 600 µm), conventional flat panel volume computed tomography (fpVCT; 466 µm), micro-fpVCT (197 µm) and secondary reconstructed fpVCT (100 µM) scans were performed and data were loaded into the navigation system. The resulting fiducial registration error (FRE) was analysed, and control of the navigation accuracy was performed. The registration process was very quick and reliable with the screws as fiducials. Compared to using the MSCT data, the micro-fpVCT data led to significantly lower FRE values, whereas conventional fpVCT and secondary reconstructed fpVCT data had no advantage in terms of accuracy. For all imaging modalities, there was no relevant visual deviation when targeting defined anatomical points with a navigation probe. fpVCT data are very well suited for electromagnetic navigation at the lateral skull base. The use of titanium screws as fiducial markers turned out to be ideal for comparing different imaging methods. A further evaluation of this approach by a clinical trial is required.
Collapse
Affiliation(s)
- Johannes Taeger
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - Franz-Tassilo Müller-Graff
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - Tilmann Neun
- Institute for Diagnostical and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - Maria Köping
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - Philipp Schendzielorz
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - Kristen Rak
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Bavaria, Germany
| |
Collapse
|
5
|
Wang J, Liu H, Ke J, Hu L, Zhang S, Yang B, Sun S, Guo N, Ma F. Image-guided cochlear access by non-invasive registration: a cadaveric feasibility study. Sci Rep 2020; 10:18318. [PMID: 33110188 PMCID: PMC7591497 DOI: 10.1038/s41598-020-75530-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/15/2020] [Indexed: 11/09/2022] Open
Abstract
Image-guided cochlear implant surgery is expected to reduce volume of mastoidectomy, accelerate recovery, and improve safety. The purpose of this study was to investigate the safety and effectiveness of image-guided cochlear implant surgery by a non-invasive registration method, in a cadaveric study. We developed a visual positioning frame that can utilize the maxillary dentition as a registration tool and completed the tunnels experiment on 5 cadaver specimens (8 cases in total). The accuracy of the entry point and the target point were 0.471 ± 0.276 mm and 0.671 ± 0.268 mm, respectively. The shortest distance from the margin of the tunnel to the facial nerve and the ossicular chain were 0.790 ± 0.709 mm and 1.960 ± 0.630 mm, respectively. All facial nerves, tympanic membranes, and ossicular chains were completely preserved. Using this approach, high accuracy was achieved in this preliminary study, suggesting that the non-invasive registration method can meet the accuracy requirements for cochlear implant surgery. Based on the above accuracy, we speculate that our method can also be applied to neurosurgery, orbitofacial surgery, lateral skull base surgery, and anterior skull base surgery with satisfactory accuracy.
Collapse
Affiliation(s)
- Jiang Wang
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hongsheng Liu
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Jia Ke
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Lei Hu
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Shaoxing Zhang
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Biao Yang
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Shilong Sun
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Na Guo
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Furong Ma
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
| |
Collapse
|
6
|
Singh DD, Schorn L, Strong EB, Grant M, Schramm A, Hufendiek K, Gellrich NC, Rana M. Computer-Assisted Secondary Orbital Reconstruction. Craniomaxillofac Trauma Reconstr 2020; 14:29-35. [PMID: 33613833 DOI: 10.1177/1943387520935004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Study Design This study presents a case-control study of 33 patients who underwent secondary orbital reconstruction, evaluating techniques and outcome. Objective Adequate functional and aesthetical appearance are main goals for secondary orbital reconstruction. Insufficient premorbid orbital reconstruction can result in hypoglobus, enophthalmos, and diplopia. Computer-assisted surgery and the use of patient-specific implants (PSIs) is widely described in the literature. The authors evaluate the use of selective laser-melted PSIs and hypothesize that PSIs are an excellent option for secondary orbital reconstruction. Methods The sample was composed of 33 patients, previously treated with primary orbital reconstruction, presenting themselves with indications for secondary reconstruction (i.e. enophthalmos, diplopia, or limited eye motility). Computed tomography and/or cone beam data sets were assessed before and after secondary reconstruction comparing intraorbital volumes, infraorbital angles, and clinical symptoms. Clinical outcomes were assessed using a standardized protocol. Results Results show a significant change in intraorbital volumes and a reduction of clinical symptoms after secondary reconstruction. Conclusions Outcomes of this study suggest that secondary orbital reconstruction can be performed routinely using selective laser-melted PSIs and titanium spacers.
Collapse
Affiliation(s)
- Daman D Singh
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Lara Schorn
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - E Bradley Strong
- Department of Otolaryngology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Michael Grant
- Plastic and Reconstructive Surgery at the R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA
| | - Alexander Schramm
- Department of Oral-, Maxillo- and Plastic Facial Surgery, University of Ulm, Ulm, Germany
| | - Karsten Hufendiek
- Department of Oral-, Maxillo- and Plastic Facial Surgery, University of Hannover, Hannover, Germany
| | - Nils-Claudius Gellrich
- Department of Oral-, Maxillo- and Plastic Facial Surgery, University of Hannover, Hannover, Germany
| | - Majeed Rana
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| |
Collapse
|
7
|
Accuracy Assessment of Different Registration and Imaging Methods on Image-Guided Surgery of Lateral Skull Base. ARCHIVES OF NEUROSCIENCE 2018. [DOI: 10.5812/ans.74051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
8
|
Ke J, Zhang SX, Hu L, Li CS, Zhu YF, Sun SL, Wang LF, Ma FR. Minimally Invasive Cochlear Implantation Assisted by Bi-planar Device: An Exploratory Feasibility Study in vitro. Chin Med J (Engl) 2017; 129:2476-2483. [PMID: 27748341 PMCID: PMC5072261 DOI: 10.4103/0366-6999.191787] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: A single drilled tunnel from the lateral mastoid cortex to the cochlea via the facial recess is essential for minimally invasive cochlear implant surgery. This study aimed to explore the safety profile of this kind of new image-guided and bi-planar device-assisted surgery procedure in vitro. Methods: Image-guided minimally invasive cochlear implantations were performed on eight cadaveric temporal bone specimens. The main procedures were: (1) temporal bone specimens were prepared for surgery and fiducial markers were registered. (2) computed tomography (CT) scans were performed for future reference. (3) CT scan images were processed and drill path was planned to minimize cochlear damage. (4) bi-planar device-assisted drilling was performed on the specimens using the registration. (5) surgical safety was evaluated by calculating the deviation between the drill and the planned paths, and by measuring the closest distance between the drilled path and critical anatomic structures. Results: Eight cases were operated successfully to the basal turn of the cochlear with intact facial nerves (FNs). The deviations from target points and entrance points were 0.86 mm (0.68–1.00 mm) and 0.44 mm (0.30–0.96 mm), respectively. The angular error between the planned and the drilled trajectory was 1.74° (1.26–2.41°). The mean distance from the edge of the drilled path to the FN and to the external canal was 0.60 mm (0.35–0.83 mm) and 1.60 mm (1.30–2.05 mm), respectively. In five specimens, the chorda tympani nerves were well preserved. In all cases, no injury happened to auditory ossicles. Conclusions: This exploratory study demonstrated the safety of the newly developed image-guided minimally invasive cochlear implantation assisted by the bi-planar device and established the operational procedures. Further, more in vitro experiments are needed to improve the system operation and its safety.
Collapse
Affiliation(s)
- Jia Ke
- Department of Otorhinolarygology - Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Shao-Xing Zhang
- Department of Otorhinolarygology - Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Lei Hu
- Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
| | - Chang-Sheng Li
- Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
| | - Yun-Feng Zhu
- Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
| | - Shi-Long Sun
- Department of Otorhinolarygology - Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Li-Feng Wang
- Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
| | - Fu-Rong Ma
- Department of Otorhinolarygology - Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, China
| |
Collapse
|
9
|
|
10
|
Stenin I, Hansen S, Becker M, Sakas G, Fellner D, Klenzner T, Schipper J. Minimally invasive multiport surgery of the lateral skull base. BIOMED RESEARCH INTERNATIONAL 2014; 2014:379295. [PMID: 25101276 PMCID: PMC4101962 DOI: 10.1155/2014/379295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/02/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Minimally invasive procedures minimize iatrogenic tissue damage and lead to a lower complication rate and high patient satisfaction. To date only experimental minimally invasive single-port approaches to the lateral skull base have been attempted. The aim of this study was to verify the feasibility of a minimally invasive multiport approach for advanced manipulation capability and visual control and develop a software tool for preoperative planning. METHODS Anatomical 3D models were extracted from twenty regular temporal bone CT scans. Collision-free trajectories, targeting the internal auditory canal, round window, and petrous apex, were simulated with a specially designed planning software tool. A set of three collision-free trajectories was selected by skull base surgeons concerning the maximization of the distance to critical structures and the angles between the trajectories. RESULTS A set of three collision-free trajectories could be successfully simulated to the three targets in each temporal bone model without violating critical anatomical structures. CONCLUSION A minimally invasive multiport approach to the lateral skull base is feasible. The developed software is the first step for preoperative planning. Further studies will focus on cadaveric and clinical translation.
Collapse
Affiliation(s)
- Igor Stenin
- Department of Otorhinolaryngology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Stefan Hansen
- Department of Otorhinolaryngology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Meike Becker
- Interactive Graphics Systems Group, Technical University Darmstadt, 64283 Darmstadt, Germany
| | - Georgios Sakas
- Interactive Graphics Systems Group, Technical University Darmstadt, 64283 Darmstadt, Germany
| | - Dieter Fellner
- Interactive Graphics Systems Group, Technical University Darmstadt, 64283 Darmstadt, Germany
| | - Thomas Klenzner
- Department of Otorhinolaryngology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Jörg Schipper
- Department of Otorhinolaryngology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| |
Collapse
|
11
|
Raza SM, See AP, Lim M. Real-time imaging with the o-arm for skull base applications: a cadaveric feasibility study. J Neurol Surg B Skull Base 2013; 73:293-301. [PMID: 24083119 DOI: 10.1055/s-0032-1321505] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 09/01/2011] [Indexed: 10/28/2022] Open
Abstract
Introduction Although intraoperative imaging/navigation has established its critical role in neurosurgery, its role in cranial base surgery is currently limited. Due to issues such as poor bony resolution and accuracy, surgeons have to rely on anatomic landmarks that can be distorted by pathology when drilling out critical structures. Though originally developed for spinal application, we hypothesized that the O-Arm could address the above issues for use in cranial base procedures. Methods A cadaveric study was performed in which heads underwent a preprocedure scan via the O-Arm, a fluoroscopic device capable of providing three-dimensional images through the use of cone-beam technology. Preprocedure scans were taken and then registered to a Stealth S7 machine (Medtronic, Inc., Minneapolis, MN, USA). Key cranial base landmarks were identified on these scans and then subsequently identified under direct visualization after (1) endoscopic endonasal dissection and (2) a middle fossa approach. We then quantified the difference in distance between the preplanned and identified structure during surgery. This difference was considered the error. Results For anterior cranial fossa structures, the mean error was 0.25 mm (anterior septum), 0.27 mm (left septum), and 0.32 mm (right septum). For middle fossa structures, the errors were: 0.11 mm (foramen spinosum), 0.44 mm (foramen rotundum), and 0.21 mm (foramen ovale). Conclusion Based on this preliminary cadaveric study, we feel the O-Arm can provide the necessary imaging resolution at the skull base to be employed for intraoperative navigation during cranial base approaches (open and endoscopic). This study warrants further investigation into its clinical use in patients undergoing similar surgical procedures.
Collapse
Affiliation(s)
- Shaan M Raza
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | | | | |
Collapse
|
12
|
Lee S, Gallia GL, Reh DD, Schafer S, Uneri A, Mirota DJ, Nithiananthan S, Otake Y, Stayman JW, Zbijewski W, Siewerdsen JH. Intraoperative C-arm cone-beam computed tomography: quantitative analysis of surgical performance in skull base surgery. Laryngoscope 2012; 122:1925-32. [PMID: 22886622 DOI: 10.1002/lary.23374] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/22/2012] [Accepted: 03/28/2012] [Indexed: 12/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine whether incorporation of intraoperative imaging via a new cone-beam computed tomography (CBCT) image-guidance system improves accuracy and facilitates resection in sinus and skull-base surgery through quantification of surgical performance. STUDY DESIGN Landmark identification and skull base ablation tasks were performed with a CBCT intraoperative image-guidance system in the experimental group and with image-guided surgery (IGS) alone based on preoperative computed tomography (CT) in the control group. METHODS Six cadaveric heads underwent preoperative CT imaging and surgical planning identifying surgical targets. Three types of surgical tasks were planned: landmark point identification, line contour identification, and volume drill-out. Key anatomic structures (carotid artery and optic nerve) were chosen for landmark identification and line contour tasks. Complete ethmoidectomy, vidian corridor drill-out, and clival resection were performed for volume ablation tasks. The CBCT guidance system was used in the experimental group and performance was assessed by metrics of target registration error, sensitivity, and specificity of excision. RESULTS Significant improvements were seen for point identification and line tracing tasks. Additional resection was performed in 67% of tasks in the CBCT group, and qualitative feedback indicated unequivocal improvement in confidence for all tasks. In review of tasks in the control group, additional resection would have been performed in 35% of tasks if an intraoperative image was available. CONCLUSIONS An experimental prototype C-arm CBCT guidance system was shown to improve surgical precision in the identification of skull base targets and increase accuracy in the ablation of surgical target volumes in comparison to using IGS alone.
Collapse
Affiliation(s)
- Stella Lee
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Bell B, Stieger C, Gerber N, Arnold A, Nauer C, Hamacher V, Kompis M, Nolte L, Caversaccio M, Weber S. A self-developed and constructed robot for minimally invasive cochlear implantation. Acta Otolaryngol 2012; 132:355-60. [PMID: 22385333 DOI: 10.3109/00016489.2011.642813] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION A robot built specifically for stereotactic cochlear implantation provides equal or better accuracy levels together with a better integration into a clinical environment, when compared with existing approaches based on industrial robots. OBJECTIVES To evaluate the technical accuracy of a robotic system developed specifically for lateral skull base surgery in an experimental set-up reflecting the intended clinical application. The invasiveness of cochlear electrode implantation procedures may be reduced by replacing the traditional mastoidectomy with a small tunnel slightly larger in diameter than the electrode itself. METHODS The end-to-end accuracy of the robot system and associated image-guided procedure was evaluated on 15 temporal bones of whole head cadaver specimens. The main components of the procedure were as follows: reference screw placement, cone beam CT scan, computer-aided planning, pair-point matching of the surgical plan, robotic drilling of the direct access tunnel, and postoperative cone beam CT scan for accuracy assessment. RESULTS The mean accuracy at the target point (round window) was 0.56 ± 0.41 mm with an angular misalignment of 0.88 ± 0.40°. The procedural time for the registration process through the completion of the drilling procedure was 25 ± 11 min. The robot was fully operational in a clinical environment.
Collapse
Affiliation(s)
- Brett Bell
- ARTORG Center, University of Bern, Switzerland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
Zusammenfassung
Chirurgische Eingriffe am Ohr stellen aufgrund der komplexen Anatomie und der Grössenverhältnisse der beteiligten anatomischen Strukturen eine Herausforderung für den HNO-Chirurgen dar. In diesem Beitrag wird ein Ansatz für die roboterbasierte Navigation zur Hörgeräteimplantation vorgestellt. Insbesondere wird auf die Möglichkeit des Fräsens von Implantatlagern im Felsenbein eingegangen. Je präziser ein Implantat im Schädel verankert werden kann, desto einfacher ist der chirurgischen Ablauf. Weiterhin, profitieren Patienten von verkürzten Operationszeiten und weniger schmerzhaften Eingriffen.
Collapse
|
15
|
Rau TS, Hussong A, Herzog A, Majdani O, Lenarz T, Leinung M. Accuracy of computer-aided geometric 3D reconstruction based on histological serial microgrinding preparation. Comput Methods Biomech Biomed Engin 2011; 14:581-94. [DOI: 10.1080/10255842.2010.487049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
16
|
Federspil PA. [New developments in computer-assisted surgery (CAS). From intraoperative imaging to ultrasound-based navigation]. HNO 2010; 57:983-9. [PMID: 19711045 DOI: 10.1007/s00106-009-1986-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ever faster processor capacity is having an impact on computer-assisted or computer-aided surgery (CAS). The fusion of different imaging modalities enables functional data such as PET-CT, for example, to be available in image-guided surgery. Referencing of image data is the key to precise navigation. Intraoperative data acquisition is a new approach to improving accuracy. Thus, intraoperative CT conducted under navigational support enables automatic referencing of up-to-date image data. Alternatively, intraoperative magnetic resonance imaging or intraoperative sonography can be performed. Ultrasound systems have already been successfully integrated in existing navigational systems to compensate for intraoperative tissue shifting. Ultrasound systems may play a role in the future as a single modality in image-guided surgery in soft tissue of the neck and skull bone.
Collapse
Affiliation(s)
- P A Federspil
- Univ.-Hals-Nasen-Ohren-Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg.
| |
Collapse
|
17
|
Majdani O, Rau TS, Baron S, Eilers H, Baier C, Heimann B, Ortmaier T, Bartling S, Lenarz T, Leinung M. A robot-guided minimally invasive approach for cochlear implant surgery: preliminary results of a temporal bone study. Int J Comput Assist Radiol Surg 2009; 4:475-86. [PMID: 20033531 DOI: 10.1007/s11548-009-0360-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Accepted: 05/07/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to create an access canal to the inner ear, by drilling, and perform the cochleostomy for cochlear implant surgery using robot guidance. METHODS A robot, a surgical drill and an Image-Guided Surgery (IGS) system were combined in a closed-loop setup. Ten temporal bones were scanned at the planning stages of the procedure. The robot guided the drill along the preplanned trajectory and created the approach. Postoperative scans were obtained. RESULTS The cochleostomy was performed completely in nine out of ten cases. This did not prove possible for one of the specimens, the target site selected being in too superficial a location in relation to the round window. No violation of the facial nerve took place, although the chorda tympani nerve was violated in one case and the stapes in two. It was obvious during preoperative planning that these structures would be violated, but this was accepted in order to maintain a safety margin from the facial nerve. No other unforeseen damage occurred. CONCLUSIONS This preliminary study suggests that robot-guided drilling of a minimally invasive approach to the cochlea might be feasible, but further improvements are necessary before any clinical application becomes possible. Where the width of the facial recess is less than 2.5 mm, the chorda tympani nerve and the ossicles are at risk.
Collapse
Affiliation(s)
- Omid Majdani
- Department of Otolaryngology Head and Neck Surgery, Clinic for Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, OE 6500, 30625, Hannover, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Miracle AC, Mukherji SK. Conebeam CT of the head and neck, part 2: clinical applications. AJNR Am J Neuroradiol 2009; 30:1285-92. [PMID: 19461061 DOI: 10.3174/ajnr.a1654] [Citation(s) in RCA: 201] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
SUMMARY Conebeam x-ray CT (CBCT) is being increasingly used for point-of-service head and neck and dentomaxillofacial imaging. This technique provides relatively high isotropic spatial resolution of osseous structures with a reduced radiation dose compared with conventional CT scans. In this second installment in a 2-part review, the clinical applications in the dentomaxillofacial and head and neck regions will be explored, with particular emphasis on diagnostic imaging of the sinuses, temporal bone, and craniofacial structures. Several controversies surrounding the emergence of CBCT technology will also be addressed.
Collapse
Affiliation(s)
- A C Miracle
- Departments of Radiology, University of Michigan Health System, University Hospital, Ann Arbor, Mich 48109-5030, USA
| | | |
Collapse
|
19
|
Klenzner T, Ngan CC, Knapp FB, Knoop H, Kromeier J, Aschendorff A, Papastathopoulos E, Raczkowsky J, Wörn H, Schipper J. New strategies for high precision surgery of the temporal bone using a robotic approach for cochlear implantation. Eur Arch Otorhinolaryngol 2008; 266:955-60. [PMID: 19015866 DOI: 10.1007/s00405-008-0825-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 09/25/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Klenzner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Bumm K, Federspil PA, Klenzner T, Majdani O, Raczkowsky J, Strauss G, Schipper J. [Update on computer- and mechatronic-assisted head and neck surgery in Germany]. HNO 2008; 56:908-15. [PMID: 18340419 DOI: 10.1007/s00106-008-1697-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A consequence of the ongoing advances in medical navigation is the development of so-called mechatronic assistant systems. Up to now, medical navigation had been used only for additional intrasurgical orientation. But improvements in accuracy in imaging and medical navigation can exceed the surgeon's possible manual accuracy of surgical manipulation. In such cases, mechatronic assistant systems can supplement certain surgical procedures in order to obtain the required precision, such as for positioning of implants. The development and possible use of such mechatronic assistant systems in the head and neck, as well as improvements in the accuracy of medical navigation, are the focus of several working groups. For coordinating and adapting the various research projects, different research groups were called to present their current projects and results in the context of ASKRA (working group for skull-base and craniofacial surgery of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery) workshops at the German Society for Computer- and Robot-Assisted Surgery (CURAC) convention on 14 October 2006 in Hanover. Different projects were presented, with topics including navigated controlled assistant systems for the frontal and lateral skull base, possibilities for sonographic-induced bone measurement, and requirements for high-precision surgery of the skull base.
Collapse
Affiliation(s)
-
- Universitäts-HNO-Klinik, Düsseldorf, Deutschland
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Affiliation(s)
- O Majdani
- HNO-Abteilung, St. Franziskus-Hospital Münster
| | | | | |
Collapse
|