Navigation accuracy after automatic- and hybrid-surface registration in sinus and skull base surgery

Abstract

ObjectiveComputer-aided-surgery in ENT surgery is mainly used for sinus surgery but navigation accuracy still reaches its limits for skull base procedures. Knowledge of navigation accuracy in distinct anatomical regions is therefore mandatory. This study examined whether navigation accuracy can be improved in specific anatomical localizations by using hybrid registration technique.Study designExperimental phantom study.SettingOperating room.Subjects and methodsThe gold standard of screw registration was compared with automatic LED-mask-registration alone, and in combination with additional surface matching. 3D-printer-based skull models with individual fabricated silicone skin were used for the experiments. Overall navigation accuracy considering 26 target fiducials distributed over each skull was measured as well as the accuracy on selected anatomic localizations.ResultsOverall navigation accuracy was <1.0 mm in all cases, showing the significantly lowest values after screw registration (0.66 ± 0.08 mm), followed by hybrid registration (0.83± 0.08 mm), and sole mask registration (0.92 ± 0.13 mm).On selected anatomic localizations screw registration was significantly superior on the sphenoid sinus and on the internal auditory canal. However, mask registration showed significantly better accuracy results on the midface. Navigation accuracy on skull base localizations could be significantly improved by the combination of mask registration and additional surface matching.ConclusionOverall navigation accuracy gives no sufficient information regarding navigation accuracy in a distinct anatomic area. The non-invasive LED-mask-registration proved to be an alternative in clinical routine showing best accuracy results on the midface. For challenging skull base procedures a hybrid registration technique is recommendable which improves navigation accuracy significantly in this operating field. Invasive registration procedures are reserved for selected challenging skull base operations where the required high precision warrants the invasiveness.

An eFTD-VP framework for efficiently generating patient-specific anatomically detailed facial soft tissue FE mesh for craniomaxillofacial surgery simulation

“…The difference was approximately 0.01 mm. The acceptable error in 3D surface registration and surgery navigation for clinical use in oral and maxillofacial surgery was reported to be less than 1 mm (Maal et al 2010; Austin and Antonyshyn 2012; Grauvogel et al 2017). Therefore, the eFTD-VP approach’s surface fitting accuracies of all three resolutions were better than the acceptable errors for surgical navigation.…”

Image-guided cochlear access by non-invasive registration: a cadaveric feasibility study

“…Several previous studies have shown that the targeting accuracy in skull base surgery must be in the sub-millimeter range to protect important structures 55 , 57 . Several working groups have attempted some preliminarily registration methods in skull base surgery, including screw markers (0.66 ± 0.08 mm) 35 , sole mask (0.92 ± 0.13 mm) 35 , a mapper cage (2.87 ± 0.98 mm) 21 , surface registration (1.59 ± 0.14 mm) 58 , and anatomic landmarks (4.37 ± 0.73 mm) 58 , which are invasive or imprecise. Our registration strategies could attain high precision and are non-invasive, although our methods have not performed in skull base surgery.…”

Registration-Free Workflow for Electromagnetic and Optical Navigation in Orbital and Craniofacial Surgery

“…The stereotactic mask is attached to the patient's face and is used for both registration and tracking, which means that the mask has to stay attached during the complete procedure. This may limit its application in reconstructive surgery of the midface 9,32 . With 3D stereophotogrammetry, the softtissue surface is captured through (3D) photographs of the patient with the DRF in place [31][32][33] .…”

“…Accurate intra-operative registration is the cornerstone to acquire reliable positional information in intra-operative navigation [1][2][3][4][5][6][7][8][9] . The ideal registration method would be non-invasive, little time consuming, not logistically challenging, automatic and thus not user dependent, usable in every patient, compatible with each tracking technique (optical and electromagnetic (EM)), not exposing the patient to additional radiation and, most of all, accurate.…”