Minimally Invasive Head Holder to Improve the Performance of Frameless Stereotactic Surgery

Abstract

Frameless stereotactic procedures crucially depend on the firmness of immobilization. Once registered, shifting of the patient leads to inaccuracy, and the patient registration has to be realigned. To overcome the drawbacks of conventional invasive fixation for neurosurgery and the widely accepted fixation with surgical tape in ENT, the Vogele-Bale-Hohner (VBH) head holder has been developed. It permits rigid, noninvasive fixation of the head by using an individualized dental cast attached to the upper jaw by vacuum. Oral intubation is uncomplicated. In addition, a special registration device providing well defined reference points can be mounted to the mouthpiece. We report the first promising clinical applications of this device.

Computer‐assisted therapy in orbital and mid‐facial reconstructions

“…Adhesive skin markers and dental splints must be applied to the patient before acquiring the CT dataset and may not be available for subsequent operations, whereas anatomical landmarks are inherently present. Invasive markers are rigidly fixed to the skull before the preoperative CT scan and remain in place until the procedure is complete (27,28). The simplest invasive registration device is the Mayfield clamp, which provides acceptable accuracy and is used routinely in neurosurgical operations.…”

Computer Assisted ENT Surgery Using Augmented Reality: Preliminary Results on the CAESAR Project

“…Since the policy of the CAESAR project is to avoid any invasive solution (e.g. fiducial bone implants) for the sole purpose of tracking or registration, the placement of tracking devices on the head of the patient will be accomplished using a dental stent and/or mouthpiece [5,6] or strapping a plastic headband around the patient's forehead or use a purpose-built head-holder [2]. From the previous experiments, a maximum alignment error of about 4mm can be expected.…”

Konzept eines rahmenlosen bildinteraktiven Navigations-systems für die Schädelbasis-, Nasen- und Nasennebenhöhlen-chirurgie

“…Erste Erfahrungen hinsichtlich eines rahmenlo sen nicht invasiven stereotaktischen Eingriffs in der Neu rochirurgie mit einer Oberkiefersplintschiene gehen auf Carini et al [5] zurück. Kitchen und Thomas [6], Gold smith et al [7] in der Neurochirurgie respektive neurootologischen Chirurgie sowie Bale et al [8] in der HNO setzen sich ebenfalls für eine rahmenlose stereotaktische Chirurgie ein. Die Berner Forschungsgruppe wollte keine zusätzlichen invasiven präoperativen Markierungen, wie …”