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

Abstract

AIMTo describe the development and validation of a novel neuronavigation-based method, which allows the quantification of the anatomical features that define an approach, as well as real-time visualization of the surgical pyramid.METHODSThe method was initially developed with commercially-available hardware for coordinate collection (a digitizer and a frameless navigation system) and software for volume rendering; dedicated neuronavigation software (ApproachViewer, part of GTx-UHN) was then developed. The accuracy of measurements and the possibility of volumetric rendering of surgical approaches simulated in a phantom were compared among three different methods and commercially-available radiological software. In the anatomy laboratory, ApproachViewer was applied to the comparative quantitative analysis of multiple neurosurgical approaches and was used by many surgeons who were untrained for the research method.RESULTSThe accuracy of ApproachViewer is comparable to commercially-available radiological software. In the anatomy laboratory, the method appears versatile. The system can be easily used after brief training. ApproachViewer allows for real-time evaluation and comparison of surgical approaches, as well as post-dissection analyses of collected data. The accuracy of the method depends on the navigation registration: with a 1-2 mm registration error, it is adequate for evaluation and comparison of most neurosurgical approaches.CONCLUSIONThis new research method and software allows semi-automated visualization, quantification, and comparison of neurosurgical approaches in the anatomy laboratory.

The IDEAL framework in neurosurgery: a bibliometric analysis

“…Following deduplication and abstract review, 51 relevant articles were identified. Thereafter remained fourteen primary papers [ 8 , 17 , 20 , 26 , 33 , 34 , 37 , 39 , 46 , 51 , 55 , 58 – 60 ], and 37 secondary papers [ 1 – 5 , 9 – 12 , 14 – 16 , 23 , 27 , 29 – 32 , 35 , 36 , 38 , 40 , 43 – 45 , 47 – 50 , 52 – 54 , 57 , 62 , 64 – 66 ].

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Skull-Base Surgery—A Narrative Review on Current Approaches and Future Developments in Surgical Navigation

“…Our group has been working with an in-house navigation software package (GTx-Eyes) [ 81 ] mostly in pre-clinical settings [ 10 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 ], and in proof-of-principle clinical studies [ 66 , 86 , 93 , 94 , 95 , 96 ] with proven benefits.…”

“…The GTx-Eyes software displays a three-dimensional image of a cone-beam computed tomography (CBCT) obtained from cadaver specimens or artificial skull models [ 88 , 97 ]. This technology allows the surgeon to locate a registered instrument or pointer tool superimposed on two-dimensional tri-planar views (e.g., axial, sagittal, coronal).…”

“…A surgical approach can be conceived as a truncated pyramid, with a superficial surface (access area) representing the area through which instruments are introduced in the patient, and a deep surface, the area exposed by the approach [ 88 ]. For example, during a transsphenoidal endoscopic approach in a cadaver, the superficial surface is represented by the nostril at the level of the pyriform aperture, while the deep surface corresponds to the posterior wall of the sphenoid sinus exposed and reached by the instrumentation [ 89 ].…”

“…Furthermore, in the post-dissection phase, it is possible to draw areas of interest on CT scans, with a sequential contouring. ApproachViewer matches each surgical pyramid with each area of interest, providing the absolute and percentage values of target areas exposed [ 88 , 89 ]. The volumetric and target areas analysis allows for an objective comparison of surgical approaches.…”