Sonographically Aided Computer-Assisted Surgery at the Skull Base—Risks and Limitations

Skull Base ◽  
2007 ◽  
Vol 16 (04) ◽  
Author(s):  
Wolfgang Maier ◽  
Petra Lohnstein ◽  
Joerg Schipper
Skull Base ◽  
2007 ◽  
Vol 16 (04) ◽  
Author(s):  
Klaus Stelter ◽  
Christoph Matthias ◽  
Kathrin Spiegl ◽  
Christian Lübbers ◽  
Andreas Leunig ◽  
...  

2004 ◽  
Vol 118 (11) ◽  
pp. 849-856 ◽  
Author(s):  
Joerg Schipper ◽  
Wolfgang Maier ◽  
Iakovos Arapakis ◽  
Uwe Spetzger ◽  
R. Laszig

A retrospective analysis of 10 patients was performed to evaluate navigation systems in extranasal frontal skull base surgery. When performing a craniotomy following a bicoronal skin incision, the surgeon has to calculate the extent of the frontal sinus to avoid unnecessary damage to the dura or mucoceles later. Due to surgical morbidity including compression of the frontal lobe, many skull base surgeons have refused to use such an approach. Malformation or bone-destruction complicates the identification of the borders and increases the risk ofside-effects. Navigation systems can be an alternative for calculating the frontal sinus outlines during surgery. In the authors’ surgical procedure two different navigation systems were used. Conventional surgery using the transfrontal, transbasal or subcranial approach consisting of trepanation and craniotomy were performed, while the navigated surgical procedure was evaluated.The analysis showed that computer-assisted surgery (CAS) is applicable to extranasal frontalskull base surgery. In comparison to X-ray beam-controlled craniotomy, CAS is beneficial as it constitutes a noninvasive instrument of quality management. Furthermore, the analysis indicatedthat under the guidance of a navigation system a precise pre-surgical simulation is available in order to perform an optimal craniotomy and reconstruction of the frontal skull base.


2009 ◽  
Vol 2 (1) ◽  
pp. 49-56
Author(s):  
Klaus Stelter ◽  
Georg Ledderose ◽  
Uta Tschiesner ◽  
Christoph Matthias ◽  
Kathrin Elisabeth Spiegl

2011 ◽  
Vol 49 (3) ◽  
pp. 364-368
Author(s):  
F. Kral ◽  
E.J. Puschban ◽  
H. Reichelmann ◽  
F. Pedross ◽  
W. Freysinger

BACKGROUND: New hardware and software algorithms in electromagnetic tracking for computer assisted surgery (CAS) have been developed. We aimed to compare electromagnetic tracking for navigated procedures in frontal skull base surgery to optical tracking. METHODS: Target registration error (TRE) was determined in 6 anatomic specimens in an experimental wet-lab. As targets, 6 titanium screws were evenly distributed over the surgical areas of interest from the frontal sinus to the clivus. Optical tracking and electromagnetic tracking was evaluated in identical software environment using a last generation commercially available navigation system. RESULTS: Submillimetric application accuracy could be achieved with both tracking modalities. Optical was more accurate than electromagnetic tracking and its reliability was better. Target position did not influence TRE, however TRE varied significantly from skull to skull. CONCLUSIONS: Although less accurate than optical tracking, electromagnetic tracking still offers excellent accuracy and reliability for anterior skull base surgery. Electromagnetic tracking is not dependent on direct line of sight between its hardware components and therefore easily integrated even in cluttered operating theatres.


Author(s):  
Sajedh M. Alturaiki ◽  
Ali Almomen ◽  
Ghaleb Al Azzeh ◽  
Abdulrahman Al Khatib ◽  
Nada Alshaikh

<p class="abstract"><strong>Background:</strong> Osteomas, ossifying fibromas, and fibrous dysplasia comprise a set of benign neoplasms known as fibro-osseous lesions (FO), which can arise in the paranasal sinuses. The vast majority of benign FO lesions (BFOL) are incidental findings on radiographs. They tend to be slow-growing tumors, and are infrequently symptomatic. The management strategy can vary significantly for theses lesions. This can range from serial, observations to aggressive surgical resection, based on symptomatology, size, and location of the lesion.</p><p class="abstract"><strong>Methods:</strong> Retrospective analysis of all the data of different symptomatic FO of the paranasal sinuses and the skull base was performed at King Fahad specialist hospital, Dammam, KSA (2006 to 2017).  </p><p class="abstract"><strong>Results:</strong> A total of 21 patients were identified; 10 (46.7%) patients were diagnosed with osteoma, 8 (38.1%) with fibrous dysplasia, 2 (9.5%) with ossifying fibroma and one (4.8%) with juvenile active ossifying (JAOF), 17 were adults and 4 were children, the range of f/u (3-60) months. 19 patients were managed by the endonasal endoscopic approach. They continue to be followed with no evidence of recurrence. Two cases required the revision combined endoscopic open approach to ensure adequate removal of the disease (residual and recurrence).</p><p><strong>Conclusions:</strong> Diagnostic dilemma of BFOL can be overcome with a combination of clinical, radiological and pathological criteria. Correct diagnosis of fibro-osseous tumors is crucial for adequate therapy as their treatment, prognosis, clinical aggressiveness and long term complications of individual entities vary significantly. Endoscopic computer-assisted surgery is the treatment of choice. Endoscopic resection remains a technical challenge. </p>


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