Der Einfluss von unterschiedlichen Registrierverfahren auf die Genauigkeit der navigiert-kontrollierten Fräse (Safety Assistance-Funktion) für die Mastoidektomie

Strauß, Gero; Dittrich, E; Baumberger, Christian; Hofer, Mathias; Strauss, Maurice B.; Stopp, Sebastian; Koulechov, Kirill; Dietz, Andreas; Lüth, Tim

doi:10.1055/s-2007-995629

Cited by 7 publications

(4 citation statements)

References 4 publications

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“…There are various reasons why CI surgery seems to be predestined for computer-assisted improvements regardless of whether the research is focussed on one or more of the steps involved in CI surgery, such as:milling the implant bed [24, 25, 72];performing the mastoidectomy [35, 36, 73, 98, 99, 116];performing the cochleostomy through a minimally invasive access [5–7, 20, 23, 51–53, 58, 64–66, 114]; orautomated insertion of the electrode array [42, 67, 79, 90, 91]. …”

Section: Introductionmentioning

confidence: 99%

Three-dimensional histological specimen preparation for accurate imaging and spatial reconstruction of the middle and inner ear

et al. 2013

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Purpose This paper presents a highly accurate cross-sectional preparation technique. The research aim was to develop an adequate imaging modality for both soft and bony tissue structures featuring high contrast and high resolution. Therefore, the advancement of an already existing microgrinding procedure was pursued. The central objectives were to preserve spatial relations and to ensure the accurate three-dimensional reconstruction of histological sections.Methods Twelve human temporal bone specimens including middle and inner ear structures were utilized. They were embedded in epoxy resin, then dissected by serial grinding and finally digitalized. The actual abrasion of each grinding slice was measured using a tactile length gauge with an accuracy of one micrometre. The cross-sectional images were aligned with the aid of artificial markers and by applying a feature-based, custom-made auto-registration algorithm. To determine the accuracy of the overall reconstruction procedure, a well-known reference object was used for comparison. To ensure the compatibility of the histological data with conventional clinical image data, the image stacks were finally converted into the DICOM standard.Results The image fusion of data from temporal bone specimens’ and from non-destructive flat-panel-based volume computed tomography confirmed the spatial accuracy achieved by the procedure, as did the evaluation using the reference object.Conclusion This systematic and easy-to-follow preparation technique enables the three-dimensional (3D) histological reconstruction of complex soft and bony tissue structures. It facilitates the creation of detailed and spatially correct 3D anatomical models. Such models are of great benefit for image-based segmentation and planning in the field of computer-assisted surgery as well as in finite element analysis. In the context of human inner ear surgery, three-dimensional histology will improve the experimental evaluation and determination of intra-cochlear trauma after the insertion of an electrode array of a cochlear implant system.

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Section: Introductionmentioning

confidence: 99%

Three-dimensional histological specimen preparation for accurate imaging and spatial reconstruction of the middle and inner ear

et al. 2013

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“…Although the more distant targets yielded slightly larger values, confirming the significant impact of the distance between the registration and target points on the accuracy [7,8,21], even the maximum deviation of 1.2 mm is still within the range (1 to 2 mm) that is often considered ''clinically acceptable'' for navigation system accuracy [1,21,25,26]. Maxillary splint-based systems with extraoral extensions for reference markers have been used previously with sufficient navigational accuracy in neurosurgery (0.29-0.86 mm [17], 0.0-2.0 mm [27]), in sinus surgery (1.56 AE 0.76 mm [28]), and in the temporal region (0.73 AE 0.25 mm [17,29]); however, only a few of these systems have been tested for targets in the lateral skull base region [15,29,30,31]. Bale et al used a mouthpiecebased registration template held in place by a vacuum system to successfully cannulate the foramen ovale [30], but did not test its applicability for Figure 3.…”

Section: Discussionmentioning

confidence: 99%

“…other locations in the lateral skull base. In contrast, insufficient accuracy was reported in an in vitro model of mastoidectomy when using a navigation bow with integrated registration markers fixed to the upper jaw [15]. A major problem with the existing devices is the large bilateral extraoral reference frame [17,29,31], which does not allow the patient's head to be positioned on one side for surgery -a prerequisite for surgery at the lateral skull base.…”

Section: Discussionmentioning

confidence: 99%

“…IGS can facilitate orientation, especially in complex surgeries such as those for recurrent cholesteatoma, paraganglioma, or CSF leaks. However, as the currently available registration methods are either highly invasive or demonstrate low reliability when applied to targets in the lateral skull base [14,15], IGS has not yet been established as a standard surgical procedure in this region.…”

Section: Introductionmentioning

confidence: 99%

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Image guided surgery of the lateral skull base: Testing a new dental splint registration device

Ledderose

Hagedorn

Spiegl

et al. 2011

Computer Aided Surgery

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Objective: The widespread use of image guided surgery in the frontolateral skull base region has been limited by the need for a reliable and non-invasive registration procedure that provides sub-millimetric accuracy. We developed and validated preclinically a non-invasive, easy-to-use registration device based on a dental splint with a laterally mounted fiducial carrier. Methods: Repeated accuracy measurements were performed on six titanium target fiducials which were screwed into the lateral skull base region of a cadaver head and could be unequivocally identified both on the CT image and in reality. The system accuracy was evaluated by determining the deviation of the real target position from the position indicated in the CT scan. The accuracy of the dental splint-based registration was compared to that of two standard registration procedures: contour-based laser surface registration and fixed marker registration. Results: The mean accuracy of 0.55 AE 0.28 mm obtained when using the maxillary splint device was similar to that obtained with the ''gold standard'' registration using bone-implanted markers (0.33 AE 0.26 mm), while being clearly superior to that obtained with contour-based laser surface registration (1.91 AE 0.74 mm). Conclusions: Registration using the non-invasively fixed maxillary fiducial platform can provide sub-millimetric accuracy in the lateral skull base region. In vivo validation may prove dental splint-based registration to be an accurate and non-invasive alternative option for image guided surgery of the lateral skull base, and may facilitate the application of navigation systems in this delicate region.

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Navigated Surgery at the Lateral Skull Base and Registration and Preoperative Imagery

Kral

Riechelmann²,

Freysinger³

2011

Arch Otolaryngol Head Neck Surg

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High-resolution CT images, 0.5 mm, of the petrous bone and a pair-point registration using loci on the patient and registration superstructures worked best under experimental conditions. Only target registration error was found to provide reliable information on accuracy intraoperatively. In line with the literature, these data prove that root mean square bears little relevance for clinical application accuracy.

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Der Einfluss von unterschiedlichen Registrierverfahren auf die Genauigkeit der navigiert-kontrollierten Fräse (Safety Assistance-Funktion) für die Mastoidektomie

Abstract: Significantly better results of the registration and drilling accuracy show up in group group 2. Thus the preconditions for clinical use are fulfilled.

Cited by 7 publications

References 4 publications

Three-dimensional histological specimen preparation for accurate imaging and spatial reconstruction of the middle and inner ear

Three-dimensional histological specimen preparation for accurate imaging and spatial reconstruction of the middle and inner ear

Image guided surgery of the lateral skull base: Testing a new dental splint registration device

Navigated Surgery at the Lateral Skull Base and Registration and Preoperative Imagery

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