Transnasal Skull Base Reconstruction Using a 3-D Endoscope: Our First Impressions

Abstract

Endoscopic endonasal duraplasty has been demonstrated to be an effective, safe, and reliable approach in most cases of skull base defects, regardless of the size. [1][2][3][4][5][6] One of the primary restrictions of the endoscopic technique, however, in contrast with microscopic procedures, is the lack of binocular vision and consequently of third dimension. In fact current endoscopic technology offers excellent resolution (high-definition [HD] cameras) but creates a two-dimensional (2-D) image that impairs depth perception and hand-eye coordination, and reduces the ability to estimate size. 7 To gain a depth cue in such a 2-D environment, surgeons seek sensorial and tactile feedback during manipulation of instruments by constantly moving the scopes in and out or from side to side. In this manner, depth perception is based on integration of indirect information from a variety of sources, including the surgeon's former knowledge of the spatial relationship between anatomical structures. 8 Recently introduced HD stereoscopes produce a threedimensional (3-D) image of the surgical field, with natural binocular ability to perceive depth, volume, and distance accurately. 9 Although in preliminary series, stereoscopic skull base surgery has proved to be a feasible and safe procedure, with outcomes comparable to those achieved with standard 2-D endoscopes. 10,11 Moreover, earlier task-based simulator studies have shown the benefit of 3-D technology in terms of speed, efficiency, and error rates when compared with the 2-D technique. 12 Thus, on the basis of these considerations and our large skull base reconstruction experience (more than 400 cases), we have begun to use 3-D endoscope in endonasal endoscopic procedures. Accordingly, in this study we report our preliminary impressions about the application of a novel 3-D endoscopic system in the field of skull base AbstractNowadays endoscopic skull base reconstruction is safely and effectively performed by means of two-dimensional (2-D) endoscopic technique. The aim of our study is to compare our 2-D experience with the novel 3-D technology in the field of skull base reconstruction techniques. In this study four patients treated with various kinds of planned duraplasty are included. The new 3-D technology was compared with the highdefinition 2-D scopes during the different steps of the procedures. The 3-D endoscopic skull base reconstruction obtained primary closure without complications in all cases. According to the subjective opinion of experienced endosurgeons, this novel technique improved depth perception, distance and size estimation, ability to identify specific anatomic structures, and hand-eye coordination. The main drawbacks detected were inferior sharpness, contrast and lighting that impaired the application of the technique in narrow sinonasal spaces. According to our preliminary impressions, 3-D endoscopic skull base reconstruction is an effective and safe procedure and could represent a significant advantage for accurate managing of the skull base region.

Clinical Comparison of 3D Endoscopic Sinonasal Surgery Between ‘Insect Eye’ 3D and ‘Twin Lens’ 3D Endoscopes

“…There was one report that the 'insect eye' 3D endoscope had no color distortion. 17) However, in this study, when comparing the real blood color, in the case of 'insect eye' 3D endoscope, slight color distortion was observed. Its color was brighter than HD-2D and 'twin lens' HD-3D endoscopes, and the distortion into fluorescent color was identified (Fig.…”

Three‐dimensional endoscopy in transnasal transsphenoidal approach to clival chordomas

“…28 The recent introduction of a 3D system and its application in the management of skull base and orbital lesions seem to improve the "hand-eye" coordination, understanding of tissues, and ability to identify anatomic structures. 16,[29][30][31] Working in a 3D environment allows for the typical stereoscopic view offered by the microscope, reducing the mental step of moving from the microscope to the endoscope. In the first steps of the surgical procedure, the Visionsense ii accuracy is limited because of the narrow corridor that is represented by the nasal fossae.…”

“…This task was completed because surgeons could switch, intraoperatively, between the 2 vision systems, pushing a button on the endoscope itself. Moreover, the evaluative parameters and scoring system were the same as those proposed by Castelnuovo et al 16 In particular, the following items were evaluated: strain sensation, dizziness, system ergonomy, color perception, light perception, sharpness, contrast, depth and size perception, identification of anatomic structures, and hand-eye coordination. The scoring was as follows: score 3 5 high advantage; score 2 5 advantage; score 1 5 low benefit; score 0 5 no significant difference; score 21 5 partial drawback; score 22 5 drawback; and score 23 5 serious drawback.…”

“…6 However, one of the primary restrictions of the endoscopic technique, in contrast with microscopic procedures, is the lack of binocular vision and the consequent lack of the third dimension. 16 Therefore, the surgeon has to achieve depth perception through tactile and visual cues, such as the interaction of the instruments or the continuous movement of the endoscope. To overcome this limitation, a novel 3D visualization system has been developed (Visionsense, Petach Tikva, Israel) and multiple publications have demonstrated the effectiveness and safety of this system for sinonasal and skull base surgery.…”

The use of neuronavigation and intraoperative imaging systems in the surgical treatment of orbital tumors

“…The panoramic view and the view from different angles are advantages of the endoscopic approach. Development of 3-dimensional endoscopes and endoscopeholders enable double-handed surgery with more exposure of the deep-seated tumors (3,17,26). Recently, Netuka et al (19) used the endoscopic technique and iMRI for the removal of 3 orbital lesions that were located on the medial wall of the orbit.…”