High-Resolution Laser Surface Scanning for Patient Registration in Cranial Computer-Assisted Surgery

Zemann

et al. 2011

BACKGROUND: Surgical navigation is a commonly used tool in cranio-maxillofacial surgery. Registration is the key element for precision, and a number of studies have shown different techniques to be accurate. Nonetheless, uncertainty surrounds the special situation in edentulous patients and a practical approach to what can be a challenging problem. MATERIALS AND METHODS: Four registration strategies for the Brainlab VectorVision(2) system are presented for surgical navigation of edentulous patients: three landmark-based, point-to-point techniques and one surface-based matching strategy are evaluated. RESULTS: The methods described differ in overall accuracy as well as in the region covered. In general, the more time-consuming and invasive the technique, the more precise it is. The non-invasive techniques are less precise, and they cover only small regions with sufficient accuracy. CONCLUSIONS: Taking into account which type of accuracy is clinically relevant and that the whole skull does not always need to be covered with the greatest possible accuracy, all the described techniques have their indications. The simpler and less invasive techniques can spare time, decrease costs, and harm patient. A decision tree is presented to the reader.

Section: Laser Surface Scanningmentioning

confidence: 70%

Registration for computer-navigated surgery in edentulous patients: A problem-based decision concept

Lübbers

Zemann

et al. 2011

“…Current computer-based three-dimensional CT datasets have opened the door to surgical navigation (Hassfeld and Muhling, 2000;Yeshwant et al, 2005a;Yeshwant et al, 2005b;Ritter et al, 2006;Luebbers et al, 2008), which does make planning transferrable to the operating room (Marmulla and Niederdellmann, 1998;Marmulla, 1999). This method is already widely used in craniomaxillofacial surgery (Hassfeld and Muhling, 2000;Gellrich et al, 2002;Schmelzeisen et al, 2002;Marmulla et al, 2004c;Schmelzeisen et al, 2004;HohlwegMajert et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Point-to-point registration with mandibulo-maxillary splint in open and closed jaw position. Evaluation of registration accuracy for computer-aided surgery of the mandible

Bettschart

Kruse

et al. 2012

INTRODUCTION:Computer navigation plays an increasingly important role in craniomaxillofacial surgery. The difficulties in computer navigation at the craniomaxillofacial site lie in the accurate transmission of the dataset to the operating room. This study investigates the accuracy of the dental-splint registration method for the skull, midface, and mandible. MATERIAL AND METHODS: A synthetic human skull model was prepared with landmarks and scanned with cone beam computer tomography (CBCT). Two registration splints fixed the mandible against the viscerocranium in two different positions (closed vs. open). The target registration error was computed in all 278 landmarks spread over the entire skull and mandible in 10 repeated measurements using the VectorVision(2) (Brain-LAB Inc., Feldkirchen, Germany) navigation system. RESULTS: If registered in the closed position an average precision of 2.07mm with a standard deviation (SD) of 0.78mm was computed for all landmarks distributed over the whole skull. Registration in the open position resulted in an average precision of 1.53mm (SD=0.55mm). For single landmarks the precision decreases linearly with distance from the reference markers. The longer the three-dimensional distance between the registration points, the more precise the computer navigation is, mainly in the most posterior area of the cranium. CONCLUSION: Our findings in the cranium are comparable with those of other studies. Artificial fixation of the lower jaw via splint seems to introduce no additional error. The registration points should be as far apart from each other as possible during navigation with the splint.

“…(Eggers et al, 2006) The structures established pre-operatively by means of a CBCT or an MDCT are transferred to the patient during registration. Gellrich et al, 2002;Schmelzeisen et al, 2002;Marmulla et al, 2004b;Schmelzeisen et al, 2004;Hohlweg-Majert et al, 2005) Registration can be subdivided into distinct groups. One differentiates between marker-based (Altobelli et al, 1993;Hassfeld et al, 1995;Howard et al, 1995;Schramm et al, 1999;Luebbers et al, 2008) and marker-free (Troitzsch et al, 2003;Marmulla et al, 2004a;Hoffmann et al, 2005;Marmulla et al, 2005b) registration techniques.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of two dental registration-splint techniques for surgical navigation in cranio-maxillofacial surgery

Venosta¹,

Sun

et al. 2014

BACKGROUND: Surgical navigation requires precise registration of the pre-operative image dataset to the patient in the operation theatre. Different marker-based and marker-free registration techniques are available, each of them with advantages and disadvantages regarding precision and clinical handling. In this model study, the precision of two dental splint techniques for marker-based registration is analyzed. MATERIALS AND METHODS: A synthetic full-size human skull was registered with its cone beam computed tomography dataset using (a) a dentally-mounted "rapid" occlusal splint with five titanium screws directly attached to the splint, (b) an "extender", a dentally-mounted occlusal splint with similar fiducials fixed to an extension of the splint. The target registration error was measured for 170 landmarks distributed over the viscero-and neurocranium in 10 repeats per splint type using the Vector Vision(2) (BrainLAB AG, Heimstetten, Germany) navigation system. Statistical and graphical evaluations were performed per anatomical region. RESULTS: In the periorbital region, the rapid splint, with an average deviation of 1.50 mm (SD = 0.439) showed greater accuracy than the extender with 1.76 mm (SD = 0.525). The viscerocranial results for both splints were similar (extender 1.84 mm, SD = 0.559, rapid occlusal splint 1.86 mm, SD = 0.686). In the cranial vault region, registration with the extender (2.33 mm, SD = 0.685) proved to be more precise than with the rapid splint (2.86 mm, SD = 0.929). CONCLUSIONS: Due to the more compact dimension of the rapid occlusal splint, errors close to the splint were smaller compared to the extender technique. The advantage of greater distances between the registration fiducials on the extender is particularly important in areas such as the orbital roof, the cranial vault, and the lateral skull base.