scholarly journals Minimally Invasive Multiport Surgery of the Lateral Skull Base

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Igor Stenin ◽  
Stefan Hansen ◽  
Meike Becker ◽  
Georgios Sakas ◽  
Dieter Fellner ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Skull Base ◽  
Temporal Bone ◽  
Preoperative Planning ◽  
Round Window ◽  
Internal Auditory Canal ◽  
Software Tool ◽  
3D Models ◽  
Petrous Apex ◽  
Lateral Skull Base

Objective. Minimally invasive procedures minimize iatrogenic tissue damage and lead to a lower complication rate and high patient satisfaction. To date only experimental minimally invasive single-port approaches to the lateral skull base have been attempted. The aim of this study was to verify the feasibility of a minimally invasive multiport approach for advanced manipulation capability and visual control and develop a software tool for preoperative planning.Methods. Anatomical 3D models were extracted from twenty regular temporal bone CT scans. Collision-free trajectories, targeting the internal auditory canal, round window, and petrous apex, were simulated with a specially designed planning software tool. A set of three collision-free trajectories was selected by skull base surgeons concerning the maximization of the distance to critical structures and the angles between the trajectories.Results. A set of three collision-free trajectories could be successfully simulated to the three targets in each temporal bone model without violating critical anatomical structures.Conclusion. A minimally invasive multiport approach to the lateral skull base is feasible. The developed software is the first step for preoperative planning. Further studies will focus on cadaveric and clinical translation.

scholarly journals Augmented Reality, Surgical Navigation, and 3D Printing for Transcanal Endoscopic Approach to the Petrous Apex

OTO Open ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. 2473974X1880449 ◽  
Author(s):  
Samuel R. Barber ◽  
Kevin Wong ◽  
Vivek Kanumuri ◽  
Ruwan Kiringoda ◽  
Judith Kempfle ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Skull Base ◽  
Surgical Planning ◽  
Preoperative Planning ◽  
Endoscopic Approach ◽  
Physical Models ◽  
Petrous Apex ◽  
Patient Specific ◽  
Lateral Skull Base ◽  
3D Printed

Otolaryngologists increasingly use patient-specific 3-dimensional (3D)–printed anatomic physical models for preoperative planning. However, few reports describe concomitant use with virtual models. Herein, we aim to (1) use a 3D-printed patient-specific physical model with lateral skull base navigation for preoperative planning, (2) review anatomy virtually via augmented reality (AR), and (3) compare physical and virtual models to intraoperative findings in a challenging case of a symptomatic petrous apex cyst. Computed tomography (CT) imaging was manually segmented to generate 3D models. AR facilitated virtual surgical planning. Navigation was then coupled to 3D-printed anatomy to simulate surgery using an endoscopic approach. Intraoperative findings were comparable to simulation. Virtual and physical models adequately addressed details of endoscopic surgery, including avoidance of critical structures. Complex lateral skull base cases may be optimized by surgical planning via 3D-printed simulation with navigation. Future studies will address whether simulation can improve patient outcomes.

Integrating Stereoscopic Video with Modular 3D Anatomic Models for Lateral Skull Base Training

2020 ◽  
Author(s):  
Samuel R. Barber ◽  
Saurabh Jain ◽  
Young-Jun Son ◽  
Kaith Almefty ◽  
Michael T. Lawton ◽  
...  
Keyword(s):  
Skull Base ◽  
Temporal Bone ◽  
Cranial Nerves ◽  
3D Models ◽  
Patient Specific ◽  
Instructional Video ◽  
Stereoscopic Video ◽  
Anatomic Structure ◽  
Lateral Skull Base ◽  
Anatomic Models

Abstract Introduction Current virtual reality (VR) technology allows the creation of instructional video formats that incorporate three-dimensional (3D) stereoscopic footage.Combined with 3D anatomic models, any surgical procedure or pathology could be represented virtually to supplement learning or surgical preoperative planning. We propose a standalone VR app that allows trainees to interact with modular 3D anatomic models corresponding to stereoscopic surgical videos. Methods Stereoscopic video was recorded using an OPMI Pentero 900 microscope (Zeiss, Oberkochen, Germany). Digital Imaging and Communications in Medicine (DICOM) images segmented axial temporal bone computed tomography and each anatomic structure was exported separately. 3D models included semicircular canals, facial nerve, sigmoid sinus and jugular bulb, carotid artery, tegmen, canals within the temporal bone, cochlear and vestibular aqueducts, endolymphatic sac, and all branches for cranial nerves VII and VIII. Finished files were imported into the Unreal Engine. The resultant application was viewed using an Oculus Go. Results A VR environment facilitated viewing of stereoscopic video and interactive model manipulation using the VR controller. Interactive models allowed users to toggle transparency, enable highlighted segmentation, and activate labels for each anatomic structure. Based on 20 variable components, a value of 1.1 × 1012 combinations of structures per DICOM series was possible for representing patient-specific anatomy in 3D. Conclusion This investigation provides proof of concept that a hybrid of stereoscopic video and VR simulation is possible, and that this tool may significantly aid lateral skull base trainees as they learn to navigate a complex 3D surgical environment. Future studies will validate methodology.

scholarly journals Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection

2019 ◽  
Vol 276 (12) ◽  
pp. 3487-3494 ◽  
Author(s):  
Piotr Trojanowski ◽  
Marcin Szymański ◽  
Agnieszka Trojanowska ◽  
Adrian Andrzejczak ◽  
Dariusz Szczepanek ◽  
...  
Keyword(s):  
Skull Base ◽  
Temporal Bone ◽  
Free Flap ◽  
Anterolateral Thigh Flap ◽  
Petrous Apex ◽  
Recipient Site ◽  
Lateral Skull Base ◽  
Anterolateral Thigh ◽  
Skull Base Defects ◽  
Alt Flap

Abstract Purpose Evaluation of the utility of the free anterolateral thigh flap reconstruction of the defects resulting from radical temporal bone resection in the management of lateral skull base malignancies in a single institution. Methods An analysis of 17 en bloc subtotal petrosectomies for removal of malignant tumours was performed. There were 12 squamous cell carcinomas, 4 basal cell carcinomas and 1 adenoid cystic carcinoma. The tumours were staged with the University of Pittsburgh TNM system. In all patients, the lateral temporal bone with the preservation of the petrous apex and carotid artery was performed. All patients had parotid gland resection. The post-resection defect was reconstructed with an ALT free flap. Results Tumour radical resection and defect reconstruction with an ALT flap was achieved in all patients without intraoperative complications. The transplants were harvested as fasciocutaneous flaps, 11 perfused by musculocutaneous and 6 by septocutaneous perforators. The ALT flaps had a mean pedicle length of 8 cm (6–12 cm), and the flap size ranged between 6 × 15 cm and 15 × 30 cm. The flaps were supplied by nine facial, five occipital and three maxillary arteries. Recipient-site veins included eight internal jugular, seven facial, one retromandibular and one external jugular vein. All arterial pedicles were anastomosed in an end-to-end manner. The veins were anastomosed with interrupted sutures and in 11 cases with Synovis-Coupler® devices. All the flap transfers were performed successfully. Three patients experienced postoperative complications. Conclusions The ALT flap proved to be effective for covering large temporal skull base defects resulting from the radical removal of temporal bone malignancies. The functional and cosmetic results were acceptable with a low complication rate.

The Surgical Management of Temporal Bone and Lateral Skull Base Defects

2016 ◽  
Vol 77 (S 02) ◽  
Author(s):  
Hannah North ◽  
Simon Freeman ◽  
Scott Rutherford ◽  
Andrew King ◽  
Chorlatte Hammerbeck-Ward ◽  
...  
Keyword(s):  
Skull Base ◽  
Temporal Bone ◽  
Surgical Management ◽  
Lateral Skull Base ◽  
Skull Base Defects

Reconstruction of Lateral Skull Base Defects after Combined Parotidectomy and Temporal Bone Resection for Advanced Malignancy

Skull Base ◽  
2011 ◽  
Vol 21 (S 01) ◽  
Author(s):  
Zoukaa Sargi ◽  
Robert Gerring ◽  
Adrien Eshraghi ◽  
David Arnold ◽  
Francisco Civantos ◽  
...  
Keyword(s):  
Skull Base ◽  
Temporal Bone ◽  
Bone Resection ◽  
Advanced Malignancy ◽  
Lateral Skull Base ◽  
Temporal Bone Resection ◽  
Skull Base Defects

Survival outcomes of lateral skull base tumors following temporal bone resection

Head & Neck ◽  
2021 ◽  
Author(s):  
Neila L. Kline ◽  
Kavita Bhatnagar ◽  
David J. Eisenman ◽  
Rodney J. Taylor
Keyword(s):  
Skull Base ◽  
Temporal Bone ◽  
Survival Outcomes ◽  
Skull Base Tumors ◽  
Bone Resection ◽  
Lateral Skull Base ◽  
Temporal Bone Resection

Multi-Disciplinary Skull Base Conference and its Effects on Patient Management

2021 ◽  
pp. 000348942110212
Author(s):  
Nathan Kemper ◽  
Scott B. Shapiro ◽  
Allie Mains ◽  
Noga Lipschitz ◽  
Joseph Breen ◽  
...  
Keyword(s):  
Skull Base ◽  
Medical Center ◽  
Academic Medical Center ◽  
Significant Proportion ◽  
Internal Auditory Canal ◽  
Patient Characteristics ◽  
Management Plan ◽  
Case Review ◽  
Retrospective Case ◽  
Lateral Skull Base

Objective: Examine the effects of a multi-disciplinary skull base conference (MDSBC) on the management of patients seen for skull base pathology in a neurotology clinic. Methods: Retrospective case review of patients who were seen in a neurotology clinic at a tertiary academic medical center for pathology of the lateral skull base and were discussed at an MDSBC between July 2019 and February 2020. Patient characteristics, nature of the skull base pathology, and pre- and post-MDSBC plan of care was categorized. Results: A total of 82 patients with pathology of the lateral skull base were discussed at a MDSBC during an 8-month study period. About 54 (65.9%) had a mass in the internal auditory canal and/or cerebellopontine angle while 28 (34.1%) had other pathology of the lateral skull base. Forty-nine (59.8%) were new patients and 33 (40.2%) were established. The management plan changed in 11 (13.4%, 7.4-22.6 95% CI) patients as a result of the skull base conference discussion. The planned management changed from some form of treatment to observation in 4 patients, and changed from observation to some form of treatment in 4 patients. For 3 patients who underwent surgery, the planned approach was altered. Conclusions: For a significant proportion of patients with pathology of the lateral skull base, the management plan changed as a result of discussion at an MDSBC. Although participants of a MDSBC would agree of its importance, it is unclear how an MDSBC affects patient outcomes.

Combining Stereoscopic Video and Virtual Reality Simulation to Maximize Education in Lateral Skull Base Surgery

2020 ◽  
Vol 162 (6) ◽  
pp. 922-925 ◽  
Author(s):  
Samuel R. Barber ◽  
Saurabh Jain ◽  
Michael A. Mooney ◽  
Kaith K. Almefty ◽  
Michael T. Lawton ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Skull Base ◽  
Temporal Bone ◽  
Stereoscopic Video ◽  
3D Slicer ◽  
3 Dimensional ◽  
Desktop Virtual Reality ◽  
Computed Tomography Images ◽  
Lateral Skull Base ◽  
Hands On

Mastery of lateral skull base (LSB) surgery requires thorough knowledge of complex, 3-dimensional (3D) microanatomy and techniques. While supervised operation under binocular microscopy remains the training gold standard, concerns over operative time and patient safety often limit novice surgeons’ stereoscopic exposure. Furthermore, most alternative educational resources cannot meet this need. Here we present proof of concept for a tool that combines 3D-operative video with an interactive, stereotactic teaching environment. Stereoscopic video was recorded with a microscope during translabyrinthine approaches for vestibular schwannoma. Digital imaging and communications in medicine (DICOM) temporal bone computed tomography images were segmented using 3D-Slicer. Files were rendered using a game engine software built for desktop virtual reality. The resulting simulation was an interactive immersion combining a 3D operative perspective from the lead surgeon’s chair with virtual reality temporal bone models capable of hands-on manipulation, label toggling, and transparency modification. This novel tool may alter LSB training paradigms.

scholarly journals The importance of flaps in reconstruction of locoregionally advanced lateral skull-base cancer defects: a tertiary otorhinolaryngology referral centre experience

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Domen Vozel ◽  
Peter Pukl ◽  
Ales Groselj ◽  
Aleksandar Anicin ◽  
Primoz Strojan ◽  
...  
Keyword(s):  
Skull Base ◽  
Neck Dissection ◽  
Temporal Bone ◽  
Free Flap ◽  
Radical Neck Dissection ◽  
Selective Neck Dissection ◽  
Flap Reconstruction ◽  
Referral Centre ◽  
Regional Flap ◽  
Lateral Skull Base

Abstract Background The aim of the study was to identify the value of extensive resection and reconstruction with flaps in the treatment of locoregionally advanced lateral skull-base cancer. Patients and methods The retrospective case review of patients with lateral skull-base cancer treated surgically with curative intent between 2011 and 2019 at a tertiary otorhinolaryngology referral centre was made. Results Twelve patients with locoregionally advanced cancer were analysed. Lateral temporal bone resection was performed in nine (75.0%), partial parotidectomy in six (50.0%), total parotidectomy in one (8.3%), ipsilateral selective neck dissection in eight (66.7%) and ipsilateral modified radical neck dissection in one patient (8.3%). The defect was reconstructed with anterolateral thigh free flap, radial forearm free flap or pectoralis major myocutaneous flap in two patients (17.0%) each. Mean overall survival was 3.1 years (SD = 2.5) and cancer-free survival rate 100%. At the data collection cut-off, 83% of analysed patients and 100% of patients with flap reconstruction were alive. Conclusions Favourable local control in lateral skull-base cancer, which mainly involves temporal bone is achieved with an extensive locoregional resection followed by free or regional flap reconstruction. Universal cancer registry should be considered in centres treating this rare disease to alleviate analysis and multicentric research.

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