Accuracy and Practicability of Different Referencing Methods in Computer-Assisted Surgery of the Lateral Skull Base

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.

Download Full-text

Intraoperative Imaging and Computer-Assisted Surgery using the O-armTM Imaging System in Pediatric Skull Base Surgery

Skull Base ◽

10.1055/s-2008-1093156 ◽

2008 ◽

Vol 18 (S 01) ◽

Author(s):

Ken Kazahaya ◽

Brian Dunham

Keyword(s):

Skull Base ◽

Imaging System ◽

Skull Base Surgery ◽

Intraoperative Imaging ◽

Computer Assisted Surgery ◽

Computer Assisted

Download Full-text

Optical and electromagnetic tracking for navigated surgery of the sinuses and frontal skull base

Rhinology Journal ◽

10.4193/rhino10.177 ◽

2011 ◽

Vol 49 (3) ◽

pp. 364-368

Author(s):

F. Kral ◽

E.J. Puschban ◽

H. Reichelmann ◽

F. Pedross ◽

W. Freysinger

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Target Position ◽

Computer Assisted Surgery ◽

Optical Tracking ◽

Computer Assisted ◽

Electromagnetic Tracking ◽

Software Environment ◽

Titanium Screws ◽

Frontal Skull Base

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.

Download Full-text

Navigation as a quality management tool in cochlear implant surgery

The Journal of Laryngology & Otology ◽

10.1258/0022215042450643 ◽

2004 ◽

Vol 118 (10) ◽

pp. 764-770 ◽

Cited By ~ 47

Author(s):

Jörg Schipper ◽

Antje Aschendorff ◽

Iakovos Arapakis ◽

Thomas Klenzner ◽

Christian Barna Teszler ◽

...

Keyword(s):

Quality Management ◽

Cochlear Implant ◽

Navigation System ◽

Cochlear Implantation ◽

Computer Assisted Surgery ◽

Management Tool ◽

Computer Assisted ◽

Implant Surgery ◽

Lateral Skull Base ◽

Cochlear Implant Surgery

This cadaver study assessed the value of navigation in cochlear implant surgery. Cochlear implantation was simulated on a cadaver using a Stryker-Leibinger navigation system and a Nucleus 24 Contour implant. A conventional surgical strategy consisting of mastoidectomy, posterior tympanotomy, and cochleostomy was performed. The navigated surgical procedure was evaluated for accuracy, reliability, reproducibility, and practicability. The technology of computer-assisted surgery is applicable in cochlear implantation and beneficial in as much as the navigation-controlled implantation constitutes a non-invasive instrument of quality management. Nevertheless, in order to keep the point accuracy below one millimeter, a referencing methodusing concealed bordering anatomical structures may be further needed to perform the cochleostomy reliably under the guidance of a navigation system. More reproducible reference systems are needed if navigated lateral skull base surgery is to be fully relied upon.

Download Full-text