A novel approach to skull‐base and orbital osteotomies through virtual planning and navigation

Abstract

Objective Computer‐assisted planning of osteotomy lines, coupled with navigation‐guided performance of planned osteotomies, is a highly innovative approach to skull‐base and orbital surgery. The aim of this pilot study is to provide an assessment of the accuracy of this novel approach in guiding the correct positioning of osteotomy lines in frontal, temporal, and orbital regions, defining the agreement between the spatial position of the planned and performed osteotomies. Methods Fifteen patients with orbital, frontal sinus, and lateral skull‐base diseases underwent virtual surgical planning. Osteotomies to access the orbit, frontal sinus, and lateral skull base were planned on computer tomography‐based three‐dimensional models. The planned osteotomies were reproduced on the operating field using a navigation system. The positions of the performed and planned osteotomies were compared. The results were described as the mean positional difference between planned and performed osteotomies and as Lin's concordance coefficient, and Bland‐Altman limits of agreement were also defined. Results The overall mean difference was 0.719 mm (95% confidence interval [CI]: 0.472 to 0.965 mm). Overall, Lin's concordance coefficient was 0.997 (95% CI: 0.996 to 0.998), and overall Bland‐Altman limits of agreement ranged from −1.407 to 2.844 mm. The smallest mean difference (0.587 mm, 95% CI: 0.244 to 0.931 mm) was calculated in the orbit group, whereas the highest mean difference (0.904 mm, 95% CI: 0.428 to 1.379 mm) was described in the lateral skull‐base group. Conclusion This study's results support the use of this novel planning and navigation protocol for guiding osteotomy in anterior and lateral skull‐base surgery, providing a clinical validation of this technique. Level of Evidence 4 Laryngoscope, 00:1–9, 2018 Laryngoscope, 129:823–831, 2019

Reduction of comminuted fractures of the anterior wall of the frontal sinus using threaded Kirschner wires and a small eyebrow incision

“…This limitation is common to all FSF surgical methods except bicoronal incision. This can be overcome using a probe method via a real-time navigation guide, which has recently attracted attention [ 21 , 22 ]. If the degree of fracture reduction is immediately judged intraoperatively using real-time navigation, an acceptable reduction result can be obtained by increasing the surgical accuracy without rigid fixation.…”

Management of Frontal Sinus Fractures

“…The development and use of patient-specific, prefabricated implants for precise and accurate reconstruction has vastly expanded over the past decade, and these techniques are useful in addressing anterior and posterior table fractures of the frontal bone. Recently, Franz et al 35 virtually preplanned osteotomy sites required to access the frontal sinus and other areas of the facial skeleton and successfully validated the technique; such planning protocols can decrease operative times and may replace historic methods of entering the frontal sinus (transillumination, 6-foot Caldwell, etc.). Patient-specific prefabricated implants have also been used for anterior table fractures; benefits include reduced operative time and improved cosmesis.…”

Augmented reality‐enhanced navigation in endoscopic sinus surgery: A prospective, randomized, controlled clinical trial

“…Image guidance facilitates anatomical orientation, which can be particularly helpful in cases of anatomical variants, revision surgery, skull base surgery and tumor diseases. [4][5][6][7][8][9] Mental workload of the surgeons can be reduced 10 and intraoperative complications can be avoided. [10][11][12] In addition, navigation systems can be a useful tool for young sinus surgeons at the beginning of their surgical training.…”

“…These systems are based on preoperative CT or MRI scans and facilitate an intraoperative guidance using specific instruments, which are preoperatively adjusted to the imaging data. Image guidance facilitates anatomical orientation, which can be particularly helpful in cases of anatomical variants, revision surgery, skull base surgery and tumor diseases 4‐9 . Mental workload of the surgeons can be reduced 10 and intraoperative complications can be avoided 10‐12 .…”