Quantification and comparison of neurosurgical approaches in the preclinical setting: literature review

Abstract

There is a growing awareness of the need for evidence-based surgery and of the issues that are specific to research in surgery. Well-conducted anatomical studies can represent the first, preclinical step for evidence-based surgical innovation and evaluation. In the last two decades, various reports have quantified and compared neurosurgical approaches in the anatomy laboratory using different methods and technology. The aim of this study was to critically review these papers. A PubMed and Scopus search was performed to select articles that quantified and compared different neurosurgical approaches in the preclinical setting. The basic characteristics that anatomically define a surgical approach were defined. Each study was analyzed for measured features and quantification method and technique. Ninety-nine papers, published from 1990 to 2013, were included in this review. A heterogeneous use of terms to define the features of a surgical approach was evident. Different methods to study these features have been reported; they are generally based on quantification of distances, angles, and areas. Measuring tools have evolved from the simple ruler to frameless stereotactic devices. The reported methods have each specific advantages and limits; a common limitation is the lack of 3D visualization and surgical volume quantification. There is a need for a uniform nomenclature in anatomical studies. Frameless stereotactic devices provide a powerful tool for anatomical studies. Volume quantification and 3D visualization of the surgical approach is not provided with most available methods.

Surgical anatomy of the parapharyngeal space: Multiperspective, quantification‐based study

“…[18][19][20][21][22] Deep surfaces of the surgical corridor were tracked by drawing with a navigated probe the perimeter of the exposed portion of the prevertebral space (for anterior approaches) or lateral pharyngeal wall (for lateral approaches). The quantification method has been previously validated by our group for quantification of skull base approaches.…”

“…The quantification method has been previously validated by our group for quantification of skull base approaches. [18][19][20][21][22] Deep surfaces of the surgical corridor were tracked by drawing with a navigated probe the perimeter of the exposed portion of the prevertebral space (for anterior approaches) or lateral pharyngeal wall (for lateral approaches). Superficial surfaces of the surgical corridor were tracked at the pyriform, oral, and skin apertures for transnasal, transoral, and lateral approaches, respectively.…”

Quantitative comparison of cranial approaches in the anatomy laboratory: A neuronavigation based research method

“…Anatomical research is an essential phase of modern surgical innovation and evaluation[ 1 ], especially in an era of technological advancements, leading to the continuous improvement of different surgical approaches and techniques[ 2 , 3 ]. In the last two decades, different methods have been described for the quantification and comparison of neurosurgical approaches in the anatomy laboratory[ 4 ]. A common limitation of currently available research methods is the lack of visualization of the surgical pyramid that anatomically defines a neurosurgical approach (Figure 1 )[ 4 , 5 ].…”

“…In the last two decades, different methods have been described for the quantification and comparison of neurosurgical approaches in the anatomy laboratory[ 4 ]. A common limitation of currently available research methods is the lack of visualization of the surgical pyramid that anatomically defines a neurosurgical approach (Figure 1 )[ 4 , 5 ].…”

“… Schematic description of a surgical approach, as a “truncated pyramid”[ 4 , 5 ]: (1) Superficial surface (A), more commonly defined “surgical window” or “access area”; it represents the area through which instruments are introduced to work at the level of the deep area; (2) deep surface (B), usually defined “area of exposure”, as it is the surface exposed by the approach; and (3) height of the truncated pyramid (dotted line). Volume and trajectory of this pyramid complete the essential anatomical definition of a neurosurgical approach.…”