Three dimensional tracking with ultrasound for augmented reality applications in skull base surgery

Abstract Introduction Endoscopic skull base approaches are broadly used in modern neurosurgery. The support of neuronavigation can help to effectively target the lesion avoiding complications. In children, endoscopic-assisted skull base surgery in combination with navigation systems becomes even more important because of the morphological variability and rare diseases affecting the sellar and parasellar regions. This paper aims to analyze our first experience on augmented reality navigation in endoscopic skull base surgery in a pediatric case series. Patients and methods A retrospective review identified seventeen endoscopic-assisted endonasal or transoral procedures performed in an interdisciplinary setting in a period between October 2011 and May 2020. In all the cases, the surgical target was a lesion in the sellar or parasellar region. Clinical conditions, MRI appearance, intraoperative conditions, postoperative MRI, possible complications, and outcomes were analyzed. Results The mean age of our patients was 14.5 ± 2.4 years. The diagnosis varied, but craniopharyngiomas (31.2%) were mostly represented. AR navigation was experienced to be very helpful for effectively targeting the lesion and defining the intraoperative extension of the pathology. In 65% of the oncologic cases, a radical removal was proven in postoperative MRI. The mean follow-up was 89 ± 79 months. There were no deaths in our series. No long-term complications were registered; two cerebrospinal fluid (CSF) fistulas and a secondary abscess required further surgery. Conclusion The implementation of augmented reality to endoscopic-assisted neuronavigated procedures within the skull base was feasible and did provide relevant information directly in the endoscopic field of view and was experienced to be useful in the pediatric cases, where anatomical variability and rarity of the pathologies make surgery more challenging.

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A Controlled Laboratory and Clinical Evaluation of a Three-dimensional Endoscope for Endonasal Sinus and Skull Base Surgery

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2011.25.3593 ◽

2011 ◽

Vol 25 (3) ◽

pp. 141-144 ◽

Cited By ~ 28

Author(s):

Rupali N. Shah ◽

W. Derek Leight ◽

Mihir R. Patel ◽

Joshua B. Surowitz ◽

Yu-Tung Wong ◽

...

Keyword(s):

Skull Base ◽

Clinical Evaluation ◽

Skull Base Surgery ◽

Three Dimensional

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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 ◽

10.1371/journal.pone.0227312 ◽

2020 ◽

Vol 15 (1) ◽

pp. e0227312 ◽

Cited By ~ 1

Author(s):

Marco Lai ◽

Simon Skyrman ◽

Caifeng Shan ◽

Drazenko Babic ◽

Robert Homan ◽

...

Keyword(s):

Computed Tomography ◽

Augmented Reality ◽

Skull Base ◽

Cone Beam Computed Tomography ◽

Surgical Navigation ◽

Skull Base Surgery ◽

Optical Tracking ◽

Cone Beam ◽

Endoscopic View

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The Role of 3D tractography in Skull Base Surgery: Technological Advances, Feasibility, and Early Clinical Assessment with Anterior Skull Base Meningiomas

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1713775 ◽

2020 ◽

Author(s):

Srikant S. Chakravarthi ◽

Melanie B. Fukui ◽

Alejandro Monroy-Sosa ◽

Lior Gonen ◽

Austin Epping ◽

...

Keyword(s):

Skull Base ◽

Cranial Nerve ◽

Skull Base Surgery ◽

Three Dimensional ◽

Qualitative Assessment ◽

Endoscopic Endonasal ◽

Olfactory Groove ◽

Volume Functional ◽

Signal Abnormality ◽

Anterior Cranial Base

Abstract Objective The aim of this study is to determine feasibility of incorporating three-dimensional (3D) tractography into routine skull base surgery planning and analyze our early clinical experience in a subset of anterior cranial base meningiomas (ACM). Methods Ninety-nine skull base endonasal and transcranial procedures were planned in 94 patients and retrospectively reviewed with a further analysis of the ACM subset. Main Outcome Measures (1) Automated generation of 3D tractography; (2) co-registration 3D tractography with computed tomography (CT), CT angiography (CTA), and magnetic resonance imaging (MRI); and (3) demonstration of real-time manipulation of 3D tractography intraoperatively. ACM subset: (1) pre- and postoperative cranial nerve function, (2) qualitative assessment of white matter tract preservation, and (3) frontal lobe fluid-attenuated inversion recovery (FLAIR) signal abnormality. Results Automated 3D tractography, with MRI, CT, and CTA overlay, was produced in all cases and was available intraoperatively. ACM subset: 8 (44%) procedures were performed via a ventral endoscopic endonasal approach (EEA) corridor and 12 (56%) via a dorsal anteromedial (DAM) transcranial corridor. Four cases (olfactory groove meningiomas) were managed with a combined, staged approach using ventral EEA and dorsal transcranial corridors. Average tumor volume reduction was 90.3 ± 15.0. Average FLAIR signal change was –30.9% ± 58.6. 11/12 (92%) patients (DAM subgroup) demonstrated preservation of, or improvement in, inferior fronto-occipital fasciculus volume. Functional cranial nerve recovery was 89% (all cases). Conclusions It is feasible to incorporate 3D tractography into the skull base surgical armamentarium. The utility of this tool in improving outcomes will require further study.

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Three-Dimensional Printing: Current Use in Rhinology and Endoscopic Skull Base Surgery

American Journal of Rhinology and Allergy ◽

10.1177/1945892419866319 ◽

2019 ◽

Vol 33 (6) ◽

pp. 770-781 ◽

Cited By ~ 2

Author(s):

Christopher M. Low ◽

Jonathan M. Morris ◽

Daniel L. Price ◽

Jane S. Matsumoto ◽

Janalee K. Stokken ◽

...

Keyword(s):

Patient Education ◽

3D Printing ◽

Skull Base ◽

Surgical Planning ◽

Skull Base Surgery ◽

Three Dimensional ◽

Educational Practice ◽

3 Dimensional ◽

Endoscopic Skull Base Surgery ◽

Surgical Teaching

Background In the discipline of rhinology and endoscopic skull base surgery (ESBS), 3-dimensional (3D) printing has found meaningful application in areas including preoperative surgical planning as well as in surgical education. However, its scope of use may be limited due to the perception among surgeons that there exists a prohibitively high initial investment in resources and time to acquire the requisite technical expertise. Nevertheless, given the ever decreasing cost of advancing technology coupled with the need to understand the complex spatial relationships of the paranasal sinuses and skull base, the use of 3D printing in rhinology and ESBS is poised to blossom. Objective Help the reader identify current or potential future uses of 3D printing technology relevant to their rhinologic clinical or educational practice. Methods A review of published literature relating to 3D printing in rhinology and ESBS was performed. Results Results were reviewed and organized into 5 overarching categories including an overview of the 3D printing process as well as applications of 3D printing including (1) surgical planning, (2) custom prosthetics and implants, (3) patient education, and (4) surgical teaching and assessment. Conclusion In the discipline of rhinology and ESBS, 3D printing finds use in the areas of presurgical planning, patient education, prosthesis creation, and trainee education. As this technology moves forward, these products will be more broadly available to providers in the clinical and educational setting. The possible applications are vast and have great potential to positively impact surgical training, patient satisfaction, and most importantly, patient outcomes.

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USE OF THREE-DIMENSIONAL ENDOSCOPY IN ENDONASAL AND ANTERIOR SKULL BASE SURGERY

10.22541/au.164001796.63082126/v1 ◽

2021 ◽

Author(s):

Amr Kholief ◽

Ahmed Youseef ◽

Ahmed Ibrahim ◽

Samy Elwany ◽

Shahz Ahmed

Keyword(s):

Clinical Study ◽

Skull Base ◽

Surgical Procedures ◽

Skull Base Surgery ◽

Intraoperative Complications ◽

Three Dimensional ◽

Anterior Skull Base ◽

Anatomical Landmarks ◽

Intraoperative Complication ◽

3D Endoscope

Objectives: The three dimensional (3D) endoscope is considered as a new surgical tool which used in different approaches in intranasal and anterior skull base surgical procedures. There are many advantages of the 3D endoscopy over the two dimensional (2D) one that have been demonstrated along clinical applications, surgical training and different experimental studies. Our study aimed to show the difference between using the 3D & 2D endoscopes during endonasal and anterior skull base surgery and its importance specially when used by novice users. Design: Our study is divided into two phases (clinical & cadaveric phases).In the clinical study we have done 52 endonasal & anterior skull base surgical procedures (26 study cases and 26 control cases).We recorded accuracy, duration and intraoperative complication for each case. The cadaveric study was performed on three cadavers, difference in accuracy and dissection time were recorded using 3D & 2D endoscopy for each side chosen by randomization. Results: In the clinical study, the cases done by 3D endoscope were significantly faster and more accurate with less intraoperative complications compared to cases done using 2D endoscope. In cadaveric dissection while using 3D endoscope there was better depth of perception regarding the anatomical landmarks compared to 2D endoscope. Conclusion: 3D endoscopy is an advanced instrument that allows better training for the coming generation of ENT surgeons. Both clinical and cadaveric studies offer a promising outcomes in both endonasal and anterior skull base surgery.

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