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Impact of a self-developed planning and self-constructed navigation system on skull base surgery: 10 years experience.
Acta Otolaryngol. 2007 Apr; 127(4):403-7.AO

Abstract

CONCLUSION

Our self-developed planning and navigation system has proven its capacity for accurate surgery on the anterior and lateral skull base. With the incorporation of augmented reality, image-guided surgery will evolve into 'information-guided surgery'.

OBJECTIVE

Microscopic or endoscopic skull base surgery is technically demanding and its outcome has a great impact on a patient's quality of life. The goal of the project was aimed at developing and evaluating enabling navigation surgery tools for simulation, planning, training, education, and performance. This clinically applied technological research was complemented by a series of patients (n=406) who were treated by anterior and lateral skull base procedures between 1997 and 2006.

MATERIALS AND METHODS

Optical tracking technology was used for positional sensing of instruments. A newly designed dynamic reference base with specific registration techniques using fine needle pointer or ultrasound enables the surgeon to work with a target error of < 1 mm. An automatic registration assessment method, which provides the user with a color-coded fused representation of CT and MR images, indicates to the surgeon the location and extent of registration (in)accuracy. Integration of a small tracker camera mounted directly on the microscope permits an advantageous ergonomic way of working in the operating room. Additionally, guidance information (augmented reality) from multimodal datasets (CT, MRI, angiography) can be overlaid directly onto the surgical microscope view. The virtual simulator as a training tool in endonasal and otological skull base surgery provides an understanding of the anatomy as well as preoperative practice using real patient data.

RESULTS

Using our navigation system, no major complications occurred in spite of the fact that the series included difficult skull base procedures. An improved quality in the surgical outcome was identified compared with our control group without navigation and compared with the literature. The surgical time consumption was reduced and more minimally invasive approaches were possible. According to the participants' questionnaires, the educational effect of the virtual simulator in our residency program received a high ranking.

Authors+Show Affiliations

Department of ORL, Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland. marco.caversaccio@insel.chNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17453461

Citation

Caversaccio, Marco, et al. "Impact of a Self-developed Planning and Self-constructed Navigation System On Skull Base Surgery: 10 Years Experience." Acta Oto-laryngologica, vol. 127, no. 4, 2007, pp. 403-7.
Caversaccio M, Langlotz F, Nolte LP, et al. Impact of a self-developed planning and self-constructed navigation system on skull base surgery: 10 years experience. Acta Otolaryngol. 2007;127(4):403-7.
Caversaccio, M., Langlotz, F., Nolte, L. P., & Häusler, R. (2007). Impact of a self-developed planning and self-constructed navigation system on skull base surgery: 10 years experience. Acta Oto-laryngologica, 127(4), 403-7.
Caversaccio M, et al. Impact of a Self-developed Planning and Self-constructed Navigation System On Skull Base Surgery: 10 Years Experience. Acta Otolaryngol. 2007;127(4):403-7. PubMed PMID: 17453461.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of a self-developed planning and self-constructed navigation system on skull base surgery: 10 years experience. AU - Caversaccio,Marco, AU - Langlotz,Frank, AU - Nolte,Lutz-Peter, AU - Häusler,Rudolf, PY - 2007/4/25/pubmed PY - 2007/8/11/medline PY - 2007/4/25/entrez SP - 403 EP - 7 JF - Acta oto-laryngologica JO - Acta Otolaryngol VL - 127 IS - 4 N2 - CONCLUSION: Our self-developed planning and navigation system has proven its capacity for accurate surgery on the anterior and lateral skull base. With the incorporation of augmented reality, image-guided surgery will evolve into 'information-guided surgery'. OBJECTIVE: Microscopic or endoscopic skull base surgery is technically demanding and its outcome has a great impact on a patient's quality of life. The goal of the project was aimed at developing and evaluating enabling navigation surgery tools for simulation, planning, training, education, and performance. This clinically applied technological research was complemented by a series of patients (n=406) who were treated by anterior and lateral skull base procedures between 1997 and 2006. MATERIALS AND METHODS: Optical tracking technology was used for positional sensing of instruments. A newly designed dynamic reference base with specific registration techniques using fine needle pointer or ultrasound enables the surgeon to work with a target error of < 1 mm. An automatic registration assessment method, which provides the user with a color-coded fused representation of CT and MR images, indicates to the surgeon the location and extent of registration (in)accuracy. Integration of a small tracker camera mounted directly on the microscope permits an advantageous ergonomic way of working in the operating room. Additionally, guidance information (augmented reality) from multimodal datasets (CT, MRI, angiography) can be overlaid directly onto the surgical microscope view. The virtual simulator as a training tool in endonasal and otological skull base surgery provides an understanding of the anatomy as well as preoperative practice using real patient data. RESULTS: Using our navigation system, no major complications occurred in spite of the fact that the series included difficult skull base procedures. An improved quality in the surgical outcome was identified compared with our control group without navigation and compared with the literature. The surgical time consumption was reduced and more minimally invasive approaches were possible. According to the participants' questionnaires, the educational effect of the virtual simulator in our residency program received a high ranking. SN - 0001-6489 UR - https://www.unboundmedicine.com/medline/citation/17453461/Impact_of_a_self_developed_planning_and_self_constructed_navigation_system_on_skull_base_surgery:_10_years_experience_ L2 - https://www.tandfonline.com/doi/full/10.1080/00016480601002104 DB - PRIME DP - Unbound Medicine ER -