Indications for computer-assisted treatment of cranio-maxillofacial tumors

Abstract

Objective: Ablative tumor surgery requires detailed planning using computed tomography (CT) or magnetic resonance imaging (MRI). Reconstruction following tumor resection is dependent on reliable information for choosing the correct type and volume of grafts and predicting the outcome. This study evaluates the benefit of and the indications for computer-assisted surgery in the treatment of cranio-maxillofacial tumors.Materials and Methods: Based on a CT or MRI data set, the STN Navigation System (Stryker-Leibinger) was used for preoperative planning, intraoperative navigation, and postoperative control of radical tumor resection and primary and secondary reconstruction. Tumor resection was preoperatively planned and intraoperatively navigated. Preoperatively, the required soft and hard tissue were measured using the mirrored data set of the unaffected side of the facial skeleton; the size and location of the graft were chosen virtually. Intraoperatively, contours of transplanted tissues were navigated in accordance with the preoperatively simulated reconstructive result.Results: Computer-assisted treatment was successfully completed in all cases of radical tumor resection, and safety margins outlined preoperatively could be precisely controlled during tumor resection. Reconstruction was designed and performed exactly as virtually planned.Conclusions: Image-guided treatment improves preoperative planning by visualization of the individual anatomy and the intended reconstructive outcome, and by objectivation of the effect of adjuvant chemo-/radiotherapy. Intraoperative navigation makes radical tumor surgery more reliable by showing the determined safety margins, preserving vital structures, and guiding reconstruction to preplanned objectives. OBJECTIVEComputer-assisted technology was initially developed to provide neurosurgeons with precise guidance during surgical procedures. Currently available systems with and without robotic navigation are in use for specific medical indications. Various intraoperative navigation systems are used to assist

Automatic extraction of the mid-facial plane for cranio-maxillofacial surgery planning

“…Recently developed computer applications provide tools for planning CMF interventions based on 3-dimensional (3D), virtual models of the patient's skull obtained from preoperative computed-tomography (CT) scans 3,6,7,13 . Interactive tools for graphical manipulation of the virtual skull models enable the surgeon to perform 3D cephalometric measurements, simulate osteotomies, relocate or mirror bone segments 4,5,16 , insert implants and grafts, and simulate 3D soft-tissue deformations 17,18 .…”

Navigation-guided resection with immediate functional reconstruction for high-grade malignant parotid tumour at skull base

“…Intraoperatively, the navigation surgery defines the safety margins and proposed tumour resection margins to allow maximum preservation of the vital structures 8,9 . During resection of the skull base, computer-assisted surgery helps to avoid damage to the dura and the brain.…”

“…The preoperative CT scan data obtained can also be used to allow virtual selection of appropriate type and contour of prosthesis or implant for immediate reconstruction following ablative surgery 8,9,13 . If primary closure can not be achieved, the resection volume can be evaluated preoperatively in the dataset to choose the most appropriate autologous graft.…”

Advanced 3-D Biomodelling Technology for Complex Mandibular Reconstruction

“…The concurrent evolution of other technologies like stereophotogrammetry (Xia et al, 2000) has enriched SL biomodelling techniques enabling the diagnosis, simulation and planning of the soft tissues component of the reconstructive procedure. Surgical navigation technology (Schramm et al, 2000& Gelrich et al, 2002) is another growing field that augmented, and in some instances substituted (Hohlweg-Majert, 2005), the role of SL in maxillofacial surgery.…”