Comparative Evaluation of 3-Dimensional High Definition and 2-Dimensional 4-K Ultra-High Definition Endoscopy Systems in Endonasal Skull Base Surgery

2020 ◽  
Vol 19 (3) ◽  
pp. 281-287
Author(s):  
Yoichi Uozumi ◽  
Masaaki Taniguchi ◽  
Tomoaki Nakai ◽  
Hidehito Kimura ◽  
Toru Umehara ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Consecutive Series ◽  
High Definition ◽  
Endoscopic Endonasal ◽  
3 Dimensional ◽  
Procedural Time ◽  
Time Required ◽  
Dural Suturing ◽  
Sellar Floor

Abstract BACKGROUND The differences between 3-dimensional (3D) high definition (HD) and 2-dimensional (2D) 4-K ultra-HD (4K) endoscopy and their respective advantages remain unclear. OBJECTIVE To evaluate the utility of these endoscopy systems in endonasal skull base surgery. METHODS Consecutive series of endoscopic endonasal surgeries performed after introduction of 3D/HD and 2D/4K systems (July 2017) were retrospectively evaluated. Sporadic cases treated with either system, or a conventional 2D standard definition (SD) system, during the rental period from March 2016 were also included. Objective comparisons between the systems were made for newly diagnosed Knosp grade 0 to 3 pituitary adenomas. Surgical procedures were divided into nasal, sphenoidal, and intradural phases, and the surgical procedural time was compared for each phase. The time required for and accuracy of suturing the sellar floor dura was also evaluated. RESULTS A total of 74 cases were treated with 3D/HD and/or 2D/4K, and 12 cases with 2D/SD. 3D/HD was advantageous in the nasal phase because of its intuitive depth perception. 2D/4K was advantageous in the intradural phase because of its superior image quality. Surgical time of the nasal phase with 3D/HD, and that of the intradural phase with 2D/4K, were significantly shorter than that with 2D/SD. The time required for and accuracy of sellar floor dural suturing showed a trend toward improving in the order of 2D/SD, 2D/4K, and 3D/HD. CONCLUSION 3D/HD and 2D/4K endoscopy systems have different advantages, which are useful in distinct surgical phases. Understanding the characteristics of endoscopy systems is important for selecting the most appropriate system for distinct surgical situations.

Use of Mixed Reality Visualization in Endoscopic Endonasal Skull Base Surgery

2019 ◽  
Vol 19 (1) ◽  
pp. 43-52 ◽  
Author(s):  
Joshua Zeiger ◽  
Anthony Costa ◽  
Joshua Bederson ◽  
Raj K Shrivastava ◽  
Alfred M C Iloreta
Keyword(s):  
Skull Base ◽  
Endoscopic Surgery ◽  
Mixed Reality ◽  
Skull Base Surgery ◽  
Anterior Skull Base ◽  
Endoscopic Endonasal ◽  
3 Dimensional ◽  
Camera View ◽  
Clinical Series ◽  
Cerebrospinal Fluid Leaks

Abstract BACKGROUND Neuronavigation systems assist with spatial orientation during endoscopic transnasal skull base surgery, but they require a correlation of 3-dimensional (3D) views with 2-dimensional (2D) radiology studies. OBJECTIVE To outline an initial experience with a novel technology platform that provides intraoperative navigation using 3D reconstructions of patient anatomy for endoscopic surgery. METHODS A retrospective study of endoscopic anterior skull base and complex paranasal procedures was performed. Data from preoperative computed tomography and magnetic resonance imaging scans were fused to create 3D digital models of patient anatomy. Using the technology developed by Surgical Theater (Mayfield Village, Ohio), these reconstructions were designed to highlight particular anatomic regions of interest. The models were studied to guide the surgical approach and anticipate critical structures. The reconstructions were linked with the navigational technology created by Brainlab (Munich, Germany) during endoscopic surgery. A dynamic image of the reconstruction was displayed alongside a matching endoscopic camera view. These 2 views could be overlaid to provide an immersive, mixed reality image of the patient's anatomy. RESULTS A total of 134 cases were performed. The pathologies included tumors of the anterior skull base or sinonasal cavity, inflammatory sinus disease, and cerebrospinal fluid leaks. Specific anatomic structures, such as the internal carotid arteries and optic nerves, were chosen for enhancement. Surgeons felt that the technology helped to guide the extent of bony dissection and to identify critical structures. CONCLUSION We describe the first clinical series of complex skull base pathologies treated using a novel mixed reality platform.

Iatrogenic Mucosal Injury during Endoscopic Endonasal Skull Base Surgery

2014 ◽  
Vol 75 (S 01) ◽  
Author(s):  
James Byrd ◽  
Eric Wang ◽  
Juan Fernandez-Miranda ◽  
Paul Gardner ◽  
Carl Snyderman
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Mucosal Injury ◽  
Endoscopic Endonasal

The “Gasket-Seal” Watertight Closure in Endoscopic Endonasal Skull Base Surgery

Skull Base ◽  
2007 ◽  
Vol 17 (S 2) ◽  
Author(s):  
Theodore Schwartz ◽  
Seth Brown ◽  
Abtin Tabaee ◽  
Vijay Anand
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Endoscopic Endonasal ◽  
Watertight Closure

Nasopharyngeal muscle patch for the management of internal carotid artery injury in endoscopic endonasal surgery

2020 ◽  
Vol 133 (5) ◽  
pp. 1382-1387 ◽  
Author(s):  
Wei-Hsin Wang ◽  
Stefan Lieber ◽  
Ming-Ying Lan ◽  
Eric W. Wang ◽  
Juan C. Fernandez-Miranda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Management Technique ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Muscle Graft

OBJECTIVEInjury to the internal carotid artery (ICA) is the most critical complication of endoscopic endonasal skull base surgery. Packing with a crushed muscle graft at the injury site has been an effective management technique to control bleeding without ICA sacrifice. Obtaining the muscle graft has typically required access to another surgical site, however. To address this concern, the authors investigated the application of an endonasally harvested longus capitis muscle patch for the management of ICA injury.METHODSOne colored silicone-injected anatomical specimen was dissected to replicate the surgical access to the nasopharynx and the stepwise dissection of the longus capitis muscle in the nasopharynx. Two representative cases were selected to illustrate the application of the longus capitis muscle patch and the relevance of clinical considerations.RESULTSA suitable muscle graft from the longus capitis muscle could be easily and quickly harvested during endoscopic endonasal skull base surgery. In the illustrative cases, the longus capitis muscle patch was successfully used for secondary prevention of pseudoaneurysm formation following primary bleeding control on the site of ICA injury.CONCLUSIONSNasopharyngeal harvest of a longus capitis muscle graft is a safe and practical method to manage ICA injury during endoscopic endonasal surgery.

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