The Current State of Visualization Techniques in Endoscopic Skull Base Surgery

Jarmula, Jakub; Andrade, Erion Júnior de; Kshettry, Varun R.; Recinos, Pablo F.

doi:10.3390/brainsci12101337

Cited by 8 publications

(12 citation statements)

References 78 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The use of AR in skull base surgery has been previously described. The use of AR for transsphenoidal resection of pituitary lesions, either in microscopic [25] or endoscopic [26][27][28] settings, has been implemented. In the setting of pituitary surgery, use of intraoperative CT and low-dose iCT protocols led to a significant reduction in effective dosage compared to a fluoroscopy-guided approach, and the use of AR has led to optimization of orientation in the surgical field, especially in cases of reoperations and anatomical variations [25].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Single-Center Experience in Microsurgical Resection of Acoustic Neurinomas and the Benefit of Microscope-Based Augmented Reality

Pojskić,

Bopp,

Saß

et al. 2024

Medicina

View full text Add to dashboard Cite

Background and Objectives: Microsurgical resection with intraoperative neuromonitoring is the gold standard for acoustic neurinomas (ANs) which are classified as T3 or T4 tumors according to the Hannover Classification. Microscope-based augmented reality (AR) can be beneficial in cerebellopontine angle and lateral skull base surgery, since these are small areas packed with anatomical structures and the use of this technology enables automatic 3D building of a model without the need for a surgeon to mentally perform this task of transferring 2D images seen on the microscope into imaginary 3D images, which then reduces the possibility of error and provides better orientation in the operative field. Materials and Methods: All patients who underwent surgery for resection of ANs in our department were included in this study. Clinical outcomes in terms of postoperative neurological deficits and complications were evaluated, as well as neuroradiological outcomes for tumor remnants and recurrence. Results: A total of 43 consecutive patients (25 female, median age 60.5 ± 16 years) who underwent resection of ANs via retrosigmoid osteoclastic craniotomy with the use of intraoperative neuromonitoring (22 right-sided, 14 giant tumors, 10 cystic, 7 with hydrocephalus) by a single surgeon were included in this study, with a median follow up of 41.2 ± 32.2 months. A total of 18 patients underwent subtotal resection, 1 patient partial resection and 24 patients gross total resection. A total of 27 patients underwent resection in sitting position and the rest in semi-sitting position. Out of 37 patients who had no facial nerve deficit prior to surgery, 19 patients were intact following surgery, 7 patients had House Brackmann (HB) Grade II paresis, 3 patients HB III, 7 patients HB IV and 1 patient HB V. Wound healing deficit with cerebrospinal fluid (CSF) leak occurred in 8 patients (18.6%). Operative time was 317.3 ± 99 min. One patient which had recurrence and one further patient with partial resection underwent radiotherapy following surgery. A total of 16 patients (37.2%) underwent resection using fiducial-based navigation and microscope-based AR, all in sitting position. Segmented objects of interest in AR were the sigmoid and transverse sinus, tumor outline, cranial nerves (CN) VII, VIII and V, petrous vein, cochlea and semicircular canals and brain stem. Operative time and clinical outcome did not differ between the AR and the non-AR group. However, use of AR improved orientation in the operative field for craniotomy planning and microsurgical resection by identification of important neurovascular structures. Conclusions: The single-center experience of resection of ANs showed a high rate of gross total (GTR) and subtotal resection (STR) with low recurrence. Use of AR improves intraoperative orientation and facilitates craniotomy planning and AN resection through early improved identification of important anatomical relations to structures of the inner auditory canal, venous sinuses, petrous vein, brain stem and the course of cranial nerves.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Overall complications included shunt-dependent hydrocephalus (Patient Nos. 1, 14, 25 and 27), CSF leak with wound healing deficit (Patient Nos 2,3,17,22,27,33,. 39 and 42, in Patient Nos.…”

mentioning

confidence: 99%

Single-Center Experience in Microsurgical Resection of Acoustic Neurinomas and the Benefit of Microscope-Based Augmented Reality

Pojskić,

Bopp,

Saß

et al. 2024

Medicina

View full text Add to dashboard Cite

show abstract

“…With the use of this filter, we only preserve points that have a neighbor within a specified radius and discard the rest. For global registration, we first tried applying RANSAC [28] with the steps explained in Open3D documentation 1 , which refers to Choi et al for the 1 http://www.open3d.org/docs/release/tutorial/pipelines/global_registration.html parameters [29]. However, the global registration phase requires a good initialization on the scales.…”

Section: Registration and Localizationmentioning

confidence: 99%

“…By using small endoscopes, urologists can perform natural orifice procedures, minimizing morbidity for patients. However, current endoscopes used in urological surgery have a limited depth and field of view, leading to impaired visibility and complicating accurate localization within the intrarenal anatomy [ 1 , 2 ]. Furthermore, factors like organic debris and blood clots (which increase throughout surgery) further impact visibility.…”

Section: Introductionmentioning

confidence: 99%

Towards navigation in endoscopic kidney surgery based on preoperative imaging

Acar,

Lu,

et al. 2023

Healthcare Tech Letters

View full text Add to dashboard Cite

Endoscopic renal surgeries have high re‐operation rates, particularly for lower volume surgeons. Due to the limited field and depth of view of current endoscopes, mentally mapping preoperative computed tomography (CT) images of patient anatomy to the surgical field is challenging. The inability to completely navigate the intrarenal collecting system leads to missed kidney stones and tumors, subsequently raising recurrence rates. A guidance system is proposed to estimate the endoscope positions within the CT to reduce re‐operation rates. A Structure from Motion algorithm is used to reconstruct the kidney collecting system from the endoscope videos. In addition, the kidney collecting system is segmented from CT scans using 3D U‐Net to create a 3D model. The two collecting system representations can then be registered to provide information on the relative endoscope position. Correct reconstruction and localization of intrarenal anatomy and endoscope position is demonstrated. Furthermore, a 3D map is created supported by the RGB endoscope images to reduce the burden of mental mapping during surgery. The proposed reconstruction pipeline has been validated for guidance. It can reduce the mental burden for surgeons and is a step towards the long‐term goal of reducing re‐operation rates in kidney stone surgery.

show abstract

“…Barriers to early endoscopy adoption included a perceived lack of benefit, both for the surgeon and patients; lack of stereoscopic vision; one-handed surgery; and reticence to master a new skill set (1,4). A similar pattern of resistance to endoscopic methods, with comparable criticisms, emerged 80 years prior when endoscopic sinus surgery was first introduced (5).…”

Section: Introductionmentioning

confidence: 99%

Ergonomic Analysis of Otologic Surgery: Comparison of Endoscope and Microscope

et al. 2023

View full text Add to dashboard Cite

Objective: The comparative postural health of surgeons performing endoscopic and microscopic otologic surgeries has been a topic of active debate, with many nascent or anecdotal reports suggesting the latter encourages suboptimal ergonomics. Using inertial body sensors to measure joint angles, this study sought to objectively evaluate and compare the ergonomics of surgeons during endoscopic and microscopic otologic surgeries. Study Design: Prospective pilot trial. Setting: Large, multicenter, academic hospital system. Performed 21 otologic operations (10 endoscopic and 11 microscopic) in November 2020 and January 2021. All attendings were fellowship trained in otology/neurotology. Subjects: Eight otolaryngologists (four attendings and four residents) performing 21 otologic surgeries (11 microscopic and 10 endoscopic). Intervention: Approach to otologic surgery: endoscope or microscope. Main Outcome Measures: Surgeons' neck and back angles while wearing ergonomic sensors affixed to either side of each major joint, mental and physical burdens and pain after each surgery (via modified NASA Task Load Index).Results: Residents' necks (9.54°microscopic vs. −4.79°endoscopic, p = 0.04) and backs (16.48°microscopic vs. 3.66°endoscopic, p = 0.01) were significantly more flexed when performing microscopic surgery than when performing endoscopic surgery, although attending neck and back flexion were comparable during microscopic and endoscopic surgeries. Attendings reported significantly higher pain levels after operating microscopically than after operating endoscopically (0.13 vs. 2.76, p = 0.01). Conclusions: Residents were found to operate with significantly higher risk back and neck postures (as defined by the validated ergonomic tool, Rapid Entire Body Assessment) when operating microscopically. Attendings reported significantly higher levels of pain after operating microscopically versus endoscopically, suggesting that the suboptimal microscopic postures adopted earlier in training may pose an indelible risk later in a surgeon's career.

show abstract

The Current State of Visualization Techniques in Endoscopic Skull Base Surgery

Cited by 8 publications

References 78 publications

Single-Center Experience in Microsurgical Resection of Acoustic Neurinomas and the Benefit of Microscope-Based Augmented Reality

Single-Center Experience in Microsurgical Resection of Acoustic Neurinomas and the Benefit of Microscope-Based Augmented Reality

Towards navigation in endoscopic kidney surgery based on preoperative imaging

Ergonomic Analysis of Otologic Surgery: Comparison of Endoscope and Microscope

Contact Info

Product

Resources

About