Navigated Surgery at the Lateral Skull Base and Registration and Preoperative Imagery

Kral, Florian; Riechelmann, Herbert; Freysinger, Wolfgang

doi:10.1001/archoto.2010.249

Cited by 16 publications

(12 citation statements)

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“…In many clinical settings, this accuracy requirement almost reaches the navigation system's inherent limit defined by the physical resolution of the CT dataset (e.g., 0.46 mm in our study). Multiple studies have shown that optically tracked navigation systems have achieved submillimetric accuracy in lateral skull base procedures, both in the clinical 13 and laboratory [14][15][16][17][18][19][20][21] settings, but there are fewer studies of the accuracy of electromagnetically tracked navigation. Miller et al reported that the middle of the IAC and arcuate eminence could be identified within an error of 2.31 mm and 1.86 mm, respectively, with the InstaTrak 3500 Plus electromagnetic image guidance system (General Electric, Fairfield, CT).…”

Section: Discussionmentioning

confidence: 99%

The accuracy of an electromagnetic navigation system in lateral skull base approaches

et al. 2016

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Section: Discussionmentioning

confidence: 99%

The accuracy of an electromagnetic navigation system in lateral skull base approaches

et al. 2016

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“…TRE(r) with anisotropic noise covariance 27 can be predicted as (5) δ ij is the Kronecker delta, ε the smallness parameter of the perturbation-theoretic approach, are the components of the FLE covariance matrix Σ FLE , r i are the coordinates of a point r expressed in the principal axes coordinate system of the fiducials; are the i-th singular values of the fiducial configuration in the principal axes. The RMS(TRE) can be measured and pre dicted 34 via (6) This quantity is accessible via repetitions of measurements and includes the uncertainty of the tip of a navigated probe, p r , RMS TRE probe (probe tip, p r ) relative to an uncertain Dynamic Reference Frame (DRF), and RMS TRE DRF (p p ) 34 in quadrature via (7) None of the in vitro studies that we are aware of 15,[34][35][36][37][38][39][40] is providing data on the experimental User Localization Error (ULE) and none compares measurements with predictions of application accuracy 25,34,[41][42][43] . The present experiments close this gap by mimicking a clinical setting and by exploiting all available information provided by an open-source navigation system.…”

Section: Europe Pmc Funders Author Manuscriptsmentioning

confidence: 99%

“…None of the in vitro studies that we are aware of 15,[34][35][36][37][38][39][40] is providing data on the experimental user localization error (ULE) and none compares measurements with predictions of application accuracy. 25,34,[41][42][43] The present experiments close this gap by mimicking a clinical setting and by exploiting all available information provided by an open-source navigation system.…”

Section: Introductionmentioning

confidence: 99%

Quantitative error analysis for computer assisted navigation: A feasibility study

et al. 2013

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Purpose-The benefit of computer-assisted navigation depends on the registration process, at which patient features are correlated to some preoperative imagery. The operator-induced uncertainty in localizing patient features -the User Localization Error (ULE) -is unknown and most likely dominating the application accuracy. This initial feasibility study aims at providing first data for ULE with a research navigation system. Methods-Active optical navigation was done in CT-images of a plastic skull, an anatomic specimen (both with implanted fiducials) and a volunteer with anatomical landmarks exclusively. Each object was registered ten times with 3, 5, 7, and 9 registration points. Measurements were taken at 10 (anatomic specimen and volunteer) and 11 targets (plastic skull). The active NDI Polaris system was used under ideal working conditions (tracking accuracy 0.23 mm root mean square, RMS; probe tip calibration was 0.18 mm RMS. Variances of tracking along the principal directions were measured as 0.18 mm 2 , 0.32 mm 2 , and 0.42 mm 2 . ULE was calculated from predicted application accuracy with isotropic and anisotropic models and from experimental variances, respectively.Results-The ULE was determined from the variances as 0.45 mm (plastic skull), 0.60 mm (anatomic specimen), and 4.96 mm (volunteer). The predicted application accuracy did not yield consistent values for the ULE.The authors declare not to have any conflict of interest. Europe PMC Funders GroupAuthor Manuscript Med Phys. Author manuscript; available in PMC 2013 July 03. Europe PMC Funders Author Manuscripts Europe PMC Funders Author ManuscriptsConclusions-Quantitative data of application accuracy could be tested against prediction models with iso-and anisotropic noise models and revealed some discrepancies. This could potentially be due to the facts that navigation and one prediction model wrongly assume isotropic noise (tracking is anisotropic), while the anisotropic noise prediction model assumes an anisotropic registration strategy (registration is isotropic in typical navigation systems). The ULE data are presumably the first quantitative values for the precision of localizing anatomical landmarks and implanted fiducials. Submillimetric localization is possible for implanted screws; anatomic landmarks are not suitable for high-precision clinical navigation.

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“…The absence of soft-tissue shift in the temporal bone makes it possible to maintain high spatial tracking accuracy of a tracked drill throughout the whole approach [12], [13]. To the best of our knowledge we are the first to confirm that a commercial neuronavigation system can indeed track a drill with attached tracking frame at high accuracy on a high resolution CT image, with corresponding mean TRE of 1.3 mm and maximum TRE of 3 mm.…”

Section: Discussionmentioning

confidence: 69%

Validation of Exposure Visualization and Audible Distance Emission for Navigated Temporal Bone Drilling in Phantoms

et al. 2012

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BackgroundA neuronavigation interface with extended function as compared with current systems was developed to aid during temporal bone surgery. The interface, named EVADE, updates the prior anatomical image and visualizes the bone drilling process virtually in real-time without need for intra-operative imaging. Furthermore, EVADE continuously calculates the distance from the drill tip to segmented temporal bone critical structures (e.g. the sigmoid sinus and facial nerve) and produces audiovisual warnings if the surgeon drills in too close vicinity. The aim of this study was to evaluate the accuracy and surgical utility of EVADE in physical phantoms.Methodology/Principal FindingsWe performed 228 measurements assessing the position accuracy of tracking a navigated drill in the operating theatre. A mean target registration error of 1.33±0.61 mm with a maximum error of 3.04 mm was found. Five neurosurgeons each drilled two temporal bone phantoms, once using EVADE, and once using a standard neuronavigation interface. While using standard neuronavigation the surgeons damaged three modeled temporal bone critical structures. No structure was hit by surgeons utilizing EVADE. Surgeons felt better orientated and thought they had improved tumor exposure with EVADE. Furthermore, we compared the distances between surface meshes of the virtual drill cavities created by EVADE to actual drill cavities: average maximum errors of 2.54±0.49 mm and −2.70±0.48 mm were found.Conclusions/SignificanceThese results demonstrate that EVADE gives accurate feedback which reduces risks of harming modeled critical structures compared to a standard neuronavigation interface during temporal bone phantom drilling.

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Navigated Surgery at the Lateral Skull Base and Registration and Preoperative Imagery

Cited by 16 publications

References 50 publications

The accuracy of an electromagnetic navigation system in lateral skull base approaches

The accuracy of an electromagnetic navigation system in lateral skull base approaches

Quantitative error analysis for computer assisted navigation: A feasibility study

Validation of Exposure Visualization and Audible Distance Emission for Navigated Temporal Bone Drilling in Phantoms

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