The Anterior Sphenoid Wall: Relative Anatomy for Sphenoidotomy

Hosemann, Werner; Gross, Rick D.; Göde, U.; Kühnel, T; Röckelein, G

doi:10.2500/105065895781873854

Cited by 15 publications

(18 citation statements)

References 14 publications

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“…During the surgery, the drill and optical fiber would be inserted into the nasal passage where the optical fiber would illuminate the sphenoid bone (located at the rear of the nasal septum), which has a thickness of approximately 2 mm. 15 Intraoperative photoacoustic images will be acquired to visualize hidden blood vessels as surgeons are drilling to remove the sphenoidal bone.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of transcranial photoacoustic imaging for interventional guidance of endonasal surgeries

et al. 2014

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Endonasal surgeries to remove pituitary tumors incur the deadly risk of carotid artery injury due to limitations with real-time visualization of blood vessels surrounded by bone. We propose to use photoacoustic imaging to overcome current limitations. Blood vessels and surrounding bone would be illuminated by an optical fiber attached to the endonasal drill, while a transducer placed on the pterional region outside of the skull acquires images. To investigate feasibility, a plastisol phantom embedded with a spherical metal target was submerged in a water tank. The target was aligned with a 1-mm optical fiber coupled to a 1064nm Nd:YAG laser. An Ultrasonix L14-5W/60 linear transducer, placed approximately 1 cm above the phantom, acquired photoacoustic and ultrasound images of the target in the presence and absence of 2-and 4-mm-thick human adult cadaveric skull specimens. Though visualized at 18 mm depth when no bone was present, the target was not detectable in ultrasound images when the 4-mm thick skull specimen was placed between the transducer and phantom. In contrast, the target was visible in photoacoustic images at depths of 17-18 mm with and without the skull specimen. To mimic a clinical scenario where cranial bone in the nasal cavity reduces optical transmission prior to drill penetration, the 2-mm-thick specimen was placed between the phantom and optical fiber, while the 4-mm specimen remained between the phantom and transducer. In this case, the target was present at depths of 15-17 mm for energies ranging 9-18 mJ. With conventional delay-and-sum beamforming, the photoacoustic signal-tonoise ratios measured 15-18 dB and the contrast measured 5-13 dB. A short-lag spatial coherence beamformer was applied to increase signal contrast by 11-27 dB with similar values for SNR at most laser energies. Results are generally promising for photoacoustic-guided endonasal surgeries.

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Section: Introductionmentioning

confidence: 99%

Feasibility of transcranial photoacoustic imaging for interventional guidance of endonasal surgeries

et al. 2014

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“…An optical fiber, coupled to a laser, would be attached to a surgical tool. During surgery, the tool and fiber will be inserted into the nasal passage where the optical fiber would illuminate the sphenoid bone which has a thickness of 0.4-8.8 mm [24,25] . Intraoperative photoacoustic images will be acquired to visualize blood vessels and sphenoidal bone.…”

Section: Introductionmentioning

confidence: 99%

Localization of Transcranial Targets for Photoacoustic-Guided Endonasal Surgeries

Bell

Ostrowski

et al. 2015

Photoacoustics

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Neurosurgeries to remove pituitary tumors using the endonasal, transsphenoidal approach often incur the risk of patient death caused by injury to the carotid arteries hidden by surrounding sphenoid bone. To avoid this risk, we propose intraoperative photoacoustic vessel visualization with an optical fiber attached to the surgical tool and an external ultrasound transducer placed on the temple. Vessel detection accuracy is limited by acoustic propagation properties, which were investigated with k-Wave simulations. In a two-layer model of temporal bone (3200 m/s sound speed, 1-4 mm thickness) and surrounding tissues, the localization error was ≤2 mm in the tranducer's axial dimension, while temporal bone curvature further degraded target localization. Phantom experiments revealed that multiple image targets (e.g. sphenoid bone and vessels) can be visualized, particularly with coherence-based beamforming, to determine tool-to-vessel proximity despite expected localization errors. In addition, the potential flexibility of the fiber position relative to the transducer and vessel was elucidated.

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“…In 98–100% the natural ostium is found medial to the base of the superior turbinate [ 333 ], [ 334 ], [ 335 ], [ 336 ], [ 337 ], [ 338 ], [ 339 ]. The distance to the choanae in caudal direction amounts to 21 ± 6 mm [ 338 ] or 2–15 mm [ 334 ]. The distance to the nasal septum in medial direction is only few mm, to the inferior edge of the posterior part of the superior turbinate is mostly less than 10 mm [ 334 ], [ 338 ].…”

Section: Type and Technique Of Endonasal Sinus Surgerymentioning

confidence: 99%