Objective: The widespread use of image guided surgery in the frontolateral skull base region has been limited by the need for a reliable and non-invasive registration procedure that provides sub-millimetric accuracy. We developed and validated preclinically a non-invasive, easy-to-use registration device based on a dental splint with a laterally mounted fiducial carrier. Methods: Repeated accuracy measurements were performed on six titanium target fiducials which were screwed into the lateral skull base region of a cadaver head and could be unequivocally identified both on the CT image and in reality. The system accuracy was evaluated by determining the deviation of the real target position from the position indicated in the CT scan. The accuracy of the dental splint-based registration was compared to that of two standard registration procedures: contour-based laser surface registration and fixed marker registration. Results: The mean accuracy of 0.55 AE 0.28 mm obtained when using the maxillary splint device was similar to that obtained with the ''gold standard'' registration using bone-implanted markers (0.33 AE 0.26 mm), while being clearly superior to that obtained with contour-based laser surface registration (1.91 AE 0.74 mm). Conclusions: Registration using the non-invasively fixed maxillary fiducial platform can provide sub-millimetric accuracy in the lateral skull base region. In vivo validation may prove dental splint-based registration to be an accurate and non-invasive alternative option for image guided surgery of the lateral skull base, and may facilitate the application of navigation systems in this delicate region.
Objective: The safest method for a reliable registration on the lateral skull base is the placement of fiducial markers into the patient's bone by screws. An alternative method is the use of a resin splint that is fixated to the maxillary dentition, which carries the fiducial markers. Then the invasive fixation using bone screws becomes unnecessary. The aim of this study was to evaluate the accuracy of a new dental reference array (DRA). Methods: The DRA was initially tested in laboratory settings and was then applied to ten patients with surgery on the lateral skull base. An individual formed maxillary dental splint was created out of polymethylmethacrylate. The Vector Vision compact® (BrainLAB, Germany) navigation system measured the deviation on several target markers at the lateral skull base in one phantom trial, one cadaver skull and ten patients. Results: The DRA was perfectly adjusted to the phantom. The average deviation was only 0.5mm. The average deviation on four different target markers in the cadaver trial was 0.6 mm. In five patients the accuracy was acceptable (<1.2mm). But in the other five cases the deviation was more than 10mm due to different problems which were analysed carefully. Discussion: The DRA could resolve the problem of invasive marker fixation with little additional effort and cost. However, the successful use depends on the individually formed dental splint, which has to be perfectly adjusted to the maxilla, because the additional weight of the extraoral part acts as a lever and may dislocate. It is essential that the splint does not cant; the reference extension must not graze the skin of the patient; during surgery no coverage should pull on the DRA, otherwise the repositioning is not accurate. When avoiding all this, the accuracy of the dental reference array is sufficient for image-guided surgery of the lateral skull base.
No abstract
2016-12-23T18:49:38
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