Image-guided Surgery of the Anterior Skull Base

Abstract

Minimally invasive surgical procedures have revolutionized surgery of the paranasal sinuses. The endonasal procedure has become standard practice due to a better understanding of pathological physiology. However, malformations, previous operations and bleeding can interfere greatly with intraoperative orientation. Together with microscopy and endoscopy, image-guided surgery has the potential to be of significant assistance to the surgeon. We evaluated the electromagnetic navigation system InstaTrak 2000 (Visualization Technologies Inc., Lawrence, MA) in 168 patients with various disorders of the paranasal sinuses who underwent endonasal surgery. The system consists of a headset attached to an electronic transmitter which is fitted on the dorsum of the nose and in the external auditory canal. With the aid of low-frequency magnetic fields the position of the instrument equipped with an electromagnetic receiver is calculated on the basis of the reaction of ferromagnetic components in the magnetic field; the location is displayed in orthogonal sections on a high resolution screen. The intraoperative accuracy of the system was estimated to be 1.2-2.8 mm. The preparation time amounted to < 10 min. No system failures were observed. The InstaTrak 2000 navigation system is only suitable for endonasal surgery. The placement of the electromagnetic transmitter and receiver allows flexible head positioning through the use of a headset. This system is a valuable aid for the surgeon under anatomically complex conditions. The technology also lends itself well to training purposes, as visualization in different sectional planes augments the understanding of anatomy and pathological anatomy.

Application of image guidance in pituitary surgery

“…[4] However, previous operations, anatomical variations, and invasion of surrounding structures may critically interfere with intraoperative orientation, thus exposing the patient to greater risk. [6]…”

“…Accordingly, proper training is necessary for the personnel in the operating room. [6] Furthermore, the technology may necessitate a larger operating room and rearrangement of other equipments in the room. This is especially salient when working with optical systems which require a clear line of sight between the infrared camera, reference arch, and pointer instruments, or with the magnet system which requires a clear magnetic field free of other metals that can cause interference.…”

Evaluation of a System for High-Accuracy 3D Image-Based Registration of Endoscopic Video to C-Arm Cone-Beam CT for Image-Guided Skull Base Surgery

“…Such lesions are particularly challenging to access endonasally due to the proximity of critical neurovasculature, including the carotid arteries and cranial nerves [2]. Due to the complexity of these surgeries, navigation systems are often used to assist the surgeon [3], and studies have shown that navigation helps reduce the morbidity of the endonasal approach [4], [5]. Active research continues to improve the accuracy of the navigation systems [6]–[8] and reports that current less invasive registration methods, e.g., surface tracing, are not sufficient for all skull base procedures.…”