Prospective evaluation of intraoperative computed tomography imaging for endoscopic sinonasal and skull‐base surgery

Batra, Pete S.; Manes, R. Peter; Ryan, Matthew W.; Marple, Bradley F.

doi:10.1002/alr.20076

Cited by 7 publications

(7 citation statements)

References 19 publications

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“…In contrast, the mobile CT systems can be used in existing surgery rooms and can be even easily transported between several surgery rooms. Batra et al demonstrated usage of mobile intraoperative CT system (xCAT, Xoran Technologies, Ann Arbor, MI, USA) without automatically-registered neuronavigation at the conclusion of endoscopic sinonasal and skull-based surgeries and in 18% of cases they performed additional intervention [ 8 ]. However, the automatically-registered navigation using xCAT mobile CT system with submillimeter accuracy (0.34 mm average) has been successfully demonstrated recently on phantoms and could be point of future studies [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

The use of an O-arm in endonasal endoscopic operations of the skull base

et al. 2021

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Background Endoscopic endonasal transsphenoidal approaches are broadly used nowadays for a vast spectrum of pathologies sited in the anterior and middle cranial fossa. The usage of neuronavigation systems (neuronavigation) in these surgeries is crucial for improving orientations deeply inside the skull and increasing patient safety. Methods The aim of this study was to assess the use of optical neuronavigation, together with an intraoperative O-arm O2 imaging system, in a group of patients with hypophyseal adenoma that underwent a transnasal transsphenoidal surgery, and correlate the accuracy and its deviation during the navigational process against the use of conventional neuronavigation that uses preoperative MRI and CT scans. The overall group consisted of six patients, between 39 and 78 years old, with a diagnosis of hypophyseal adenoma. Patients were treated with an endoscopic transsphenoidal technique and all of them underwent preoperative MRI and CT scans of the brain. These images were used in the neuronavigation system StealthStation S7® during the surgery, where we defined two bony anatomical landmarks, such as a vomer or the origin of an intrasphenoidal septum, in each operated patient. The tip of the navigational instrument, under endoscopic control, pointed to these landmarks and the distance between the tip and the bony structure was measured on the neuronavigation system. Afterwards, intraoperative 3D x-ray imaging was performed via the mobile system O-arm O2® system with automatic transfer into the navigational system. Under endoscopic guidance, we localized the identical bony anatomical landmarks used in the previous measurement and re-measured the distance between the tip and bony landmark in images acquired by the O-arm. The results of both measurements were statistically compared. Results The mean error of accuracy during conventional neuronavigation with usage of preoperative CT and MRI scans was 2.65 mm. During the neuronavigation, with utilization of intraoperative 3D O-arm images, the mean error of accuracy 0 mm. These mean errors of accuracy (both measurement methods were compared by nonparametric Wilcoxon test) had a statistically significant difference (p = 0.043). Conclusions Based on this preliminary clinical study, we conclude that the O-arm is capable of providing intraoperative x-ray 3D images in sufficient spatial resolution in a clinically feasible acquisition. The mean error of accuracy during intraoperative navigation, based on 3D O-arm scans at the skull base, is significantly lower compared to the usage of navigation using conventional presurgical CT and MRI images. This suggests the suitability of this method for utilization during endoscopic endonasal skull base approaches.

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Section: Discussionmentioning

confidence: 99%

The use of an O-arm in endonasal endoscopic operations of the skull base

et al. 2021

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“…In a recent study, use of intraoperative CT scanning resulted in additional intervention being performed in 18% of cases, demonstrating an important adjunctive role that may improve clinical outcomes. 14…”

Section: Discussionmentioning

confidence: 99%

Clinical Consensus Statement

Setzen

Ferguson

Han

et al. 2012

Otolaryngol.--head neck surg.

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Objective. To develop a consensus statement on the appropriate use of computed tomography (CT) for paranasal sinus disease.Subjects and Methods. A modified Delphi method was used to refine expert opinion and reach consensus by the panel.Results. After 3 full Delphi rounds, 33 items reached consensus and 16 statements were dropped because of not reaching consensus or redundancy. The statements that reached consensus were grouped into 4 categories: pediatric sinusitis, medical management, surgical planning, and complication of sinusitis or sinonasal tumor. The panel unanimously agreed with 13 of the 33 statements. In addition, at least 75% of the panel strongly agreed with 14 of 33 statements across all of the categories.Conclusions. For children, careful consideration should be taken when performing CT imaging but is needed in the setting of treatment failures and complications, either of the pathological process itself or as a result of iatrogenic (surgical) complications. For adults, imaging is necessary in surgical planning, for treatment of medical and surgical complications, and in all aspects of the complete management of patients with sinonasal and skull base pathology.

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“…Intraoperative surgical navigation is invaluable and intraoperative imaging can be beneficial in particular skull base pathologies. 84-88…”

Section: Endoscopic Endonasal Approachmentioning

confidence: 99%

“…Intraoperative surgical navigation is invaluable and intraoperative imaging can be beneficial in particular skull base pathologies. [84][85][86][87][88] The patient is placed in a semi-recumbent position to optimize venous outflow. The degree of head rotation and neck extension/flexion depends on the location and characteristics of the lesion.…”

Section: General Backgroundmentioning

confidence: 99%

Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches

et al. 2021

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The sellar, suprasellar, and parasellar space contain a vast array of pathologies, including neoplastic, congenital, vascular, inflammatory, and infectious etiologies. Symptoms, if present, include a combination of headache, eye pain, ophthalmoplegia, visual field deficits, cranial neuropathy, and endocrine manifestations. A special focus is paid to key features on CT and MRI that can help in differentiating different pathologies. While most lesions ultimately require histopathologic evaluation, expert knowledge of skull base anatomy in combination with awareness of key imaging features can be useful in limiting the differential diagnosis and guiding management. Surgical techniques, including endoscopic endonasal and transcranial neurosurgical approaches are described in detail.

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Prospective evaluation of intraoperative computed tomography imaging for endoscopic sinonasal and skull‐base surgery

Cited by 7 publications

References 19 publications

The use of an O-arm in endonasal endoscopic operations of the skull base

The use of an O-arm in endonasal endoscopic operations of the skull base

Clinical Consensus Statement

Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches

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