Submillimetrische 3D-Navigation im Felsenbein

Abstract

These results show that intraoperative 3-D navigation can be successfully transferred to a clinical application in the petrous bone or at the cerebellopontine angle with satisfactory accuracy in this highly sensitive anatomic region, even if only a restricted area of the patient can be used for the referencing procedure.

Lernkurve bei der Registrierung navigierter Eingriffe an der Schädelbasis

“…Hier werden die pr ä operativen Daten mit der Patientenanatomie zur Deckung gebracht. Haupts ä chlich kommen [8,9 ], bei hochaufl ö senden Datens ä tzen der lateralen Sch ä delbasis ist die radiologisch dargestellte Oberfl ä che sehr klein ist und bietet kaum eindeutige Konturen. Hier kommt ü blicherweise die Punkt-zu-Punkt Registrierung anhand von zuvor implantierten Titanschrauben zur Anwendung [10,11] .…”

Highly precise navigation at the lateral skull base by the combination of flat-panel volume CT and electromagnetic navigation

“…The registration accuracy was similar to the implanted screws and superior to surface registration. 15 Different modalities of radiological imaging have been used for navigation, mainly multislice computed tomography (MSCT), 1,[7][8][9][13][14][15]18 but also flat panel computed tomography (fpCT) 17 and flat panel volume computed tomography (fpVCT). 10 A fpVCT system has an innovative design that allows higher spatial resolution for the visualization of complex human anatomy in comparison to MSCT scanners.…”

“…2 Different navigation systems have been used at the lateral skull base, like electromechanical systems, [3][4][5] electromagnetic systems [6][7][8][9][10][11][12] or optical systems. 1,7,[13][14][15][16][17][18] In some studies, the precision of these navigation modalities was specifically compared. Ecke et al 7 reported that different optical systems varied considerably in the accuracy between laboratory and clinic, whereas the electromagnetic system showed similar results in both settings.…”

“…For precise navigation, an exact registration is of major importance. Various approaches have been used for registration, like externally fixed systems including maxillary splint registration, 4,5,13 fixed fiducial markers 9,12,14,17 and combined techniques. 7,8,10 In other studies, the different registration approaches were compared, for example, bone-implanted markers or contour-based laser surface registration with a newly developed maxillary dental splint device with a laterally mounted fiducial carrier.…”

“…Different navigation systems have been used at the lateral skull base, like electromechanical systems, 3 – 5 electromagnetic systems 6 – 12 or optical systems. 1 , 7 , 13 – 18 …”