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Ghosh D, Majhi S, Choudhary A, Samaddar S, Guha A, Kumar S, Maitra M, Sengupta A. Endoscopic Endonasal Trans-Sphenoidal Minimally Invasive Pituitary Surgery with Image Guided Navigation System (Igns): Learning Experience of Ent Surgeon: First Author. Indian J Otolaryngol Head Neck Surg 2024; 76:953-965. [PMID: 38440488 PMCID: PMC10909064 DOI: 10.1007/s12070-023-04334-8] [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: 06/26/2023] [Accepted: 10/31/2023] [Indexed: 03/06/2024] Open
Abstract
Introduction- Endoscopic minimally invasive pituitary surgery (MIPS) is advantageous over microscopic technique, as it provides superior close up, wide angle view of surgical target area. Image guided navigation system (IGNS) guides the surgeon to localize the lesion. In the present study we analyzed the Image Guided Surgical procedure and outcome of Endoscopic minimally invasive pituitary surgery and shared our experiences regarding disease clearance. MATERIALS AND METHODS During the period of April 2015 to August 2022 a total 104 patients, diagnosed with pituitary adenoma underwent surgery and further followed up in a multidisciplinary team approach in a tertiary care hospital of Kolkata, India. The data obtained were reviewed statistically to satisfy the study objectives. RESULTS Total 104 operations were done on 98 patients and total cases taken for calculation and analysis was 98, which consist of 11 microadenomas, 81 macroadenomas. Among 35 patients with normal preoperative hormonal assay, one patient developed postoperative hypopituitarism. Among 6 patients with preoperative hypopituitarism 4 patients (66.6%) recovered after surgery. Overall, 85 cases had total disease clearance as detected on post-operative MRI. In functioning pituitary adenoma (FPA) clinical and endocrinological improvement occurred after primary surgery in 85.36% (n = 35) and after revision surgery it was 84.44% (n = 38). Macroadenomas, giant adenomas were found to have statistically significant higher risk of incomplete disease clearance but large adenomas do not have statistically higher risk of incomplete clearance. CONCLUSION IGNS requires extra time for setup, but with proper registration of tracker instruments it adds precision to the surgery. IGNS supplements endoscopic visualization with localization of target lesion by real time stereotactic feedback using preset preoperative imaging data, thus increasing accuracy, safety and effectiveness of minimally invasive surgery.
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Affiliation(s)
- Debasish Ghosh
- Department of ENT, IORL &HNS, Institute of Post Graduate Medical Education and Research, 700020 Kolkata, India
| | - Srikrishna Majhi
- Department Of Neurosurgery, Medical College and Hospital, Kolkata, 700073 West Bengal India
| | - Ankit Choudhary
- Department of ENT, IORL &HNS, Institute of Post Graduate Medical Education and Research, 700020 Kolkata, India
| | - Saikat Samaddar
- Department of ENT, IORL &HNS, Institute of Post Graduate Medical Education and Research, 700020 Kolkata, India
| | - Abhijit Guha
- Ramkrishna Mission Sikshanamandira, Belur Math, Howrah, West Bengal India
| | - Soutrik Kumar
- Department of ENT, IORL &HNS, Institute of Post Graduate Medical Education and Research, 700020 Kolkata, India
| | - Mainak Maitra
- Department of ENT, IORL &HNS, Institute of Post Graduate Medical Education and Research, 700020 Kolkata, India
| | - Arunabha Sengupta
- Department of ENT, IORL &HNS, Institute of Post Graduate Medical Education and Research, 700020 Kolkata, India
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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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Begaud L, Patron V, Escalard C, Hitier M, Hamon M, Humbert M. Radiological relationship of the ethmoid slit with the frontal sinus and the anterior ethmoidal artery and applications to the frontal sinus drillout. Eur Arch Otorhinolaryngol 2023; 280:227-233. [PMID: 35771279 DOI: 10.1007/s00405-022-07527-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/24/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To compare two types of CT acquisition parameters: CT scan of the facial bone and CT scan of the sinuses, for studying the ethmoidal slit and its relationship with the frontal sinus and anterior ethmoidal artery. MATERIALS AND METHODS Retrospective study of 145 scans of the sinuses and 79 of the facial bones performed between 2012 and 2016. On each scan, the visibility of the ethmoidal slits, their length, their distance from the ethmoidal artery, and their relationship with the anterior and posterior wall of the frontal sinus were studied. RESULTS The ethmoidal slit was better visualized on CT scans of the facial bone (58.2%) than on those of the sinuses (43.1%) (p = 0.02). The distance between the anterior ethmoidal artery and the anterior part of the cribriform plate was 9.3 mm for CT scans of the facial bone and 8.4 mm for CT scans of the sinuses. The theoretical risk of damaging the glabellar soft tissue and that of damaging the meninges during a frontal sinusotomy was evaluated, respectively, at 9.6% and 26.1% for CT scans of the facial bone, and at 6.2% and 21.5% for sinus scans. CONCLUSIONS CT scans of the facial bone are better than CT scans of the sinuses for identifying ethmoidal slits and their distance from the canal of the anterior ethmoidal artery. The identification of these elements is relevant for the surgeon during frontal sinus surgery and makes it possible to assess the risk of damaging the glabellar soft tissue or meninges. Performing a CT scan of the facial bone seems preferable to that of a CT scan of the sinuses in certain pathological situations, such as cerebrospinal rhinorrhea or revision surgeries of the frontal sinus.
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Affiliation(s)
- Laurie Begaud
- Department of Radiology, CHU de Caen, 14000, Caen, France
| | - Vincent Patron
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France.
| | | | - Martin Hitier
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France.,Department Anatomy, UNICAEN, 14032, Caen, France
| | - Michèle Hamon
- Department of Radiology, CHU de Caen, 14000, Caen, France
| | - Maxime Humbert
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France
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Talmadge J, Jiang ZY, Zebda DA, Yao WC, Luong AU, Citardi MJ. Contour Map Point Distribution and Surgeon Experience Level Affect Accuracy of Surgical Navigation in a Pilot Study. Ann Otol Rhinol Laryngol 2021; 131:397-402. [PMID: 34121472 DOI: 10.1177/00034894211005982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reliable use of surgical navigation depends upon the registration process. The gold standard is paired-point registration with bone-anchored fiducials, but contour-map registration is more practical. Surgeons may employ variable contour maps and less experienced team members often perform this critical step. The impact of these practices on target registration error (TRE) is not well-studied. METHODS A dry lab set-up consisting of a navigation system (Fusion ENT, Medtronic, Jacksonville, FL) and a sinus phantom with 2 mm radiopaque spheres in the sphenoid and ethmoid regions was developed. A CT (0.625 mm slice thickness) was obtained. Registration was performed with a contour-based protocol. Accuracy was determined using the software's distance measurement tool. Registration was performed with narrow-field (NF; forehead points medial to the mid-pupillary line) and wide field (WF; entire forehead) contour maps. An experienced rhinologist and a resident surgeon performed each registration in triplicate and TRE at the sphenoid and ethmoid markers was measured in triplicate. RESULTS WF mapping had a lower TRE than NF (1.09 mm [95% Confidence Interval (CI) 0.96-1.22] vs 1.68 mm [95% CI 1.50-1.86]). The experienced surgeon had a lower TRE compared to the resident (1.21 mm [95% CI 1.08-1.34] vs 1.54 mm [95% CI 1.35-1.74]). CONCLUSIONS In this navigation model, wide field mapping offers better accuracy than narrow-field mapping, and an experienced surgeon seemed to achieve better accuracy than a resident surgeon. These observations have potential implications for the use of this technology in the operating room.
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Affiliation(s)
- Jason Talmadge
- Department of Otolaryngology & Communication Sciences, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Zi Yang Jiang
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Denna A Zebda
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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