Noninvasive Registration Strategies and Advanced Image Guidance Technology for Submillimeter Surgical Navigation Accuracy in the Lateral Skull Base.

Schneider, Daniel; Hermann, Jan; Gerber, Kate A; Ansó, Juan; Caversaccio, Marco D.; Weber, Stefan; Anschütz, Lukas (2018). Noninvasive Registration Strategies and Advanced Image Guidance Technology for Submillimeter Surgical Navigation Accuracy in the Lateral Skull Base. Otology & neurotology, 39(10), pp. 1326-1335. Lippincott Williams & Wilkins 10.1097/MAO.0000000000001993

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HYPOTHESIS Combining novel registration strategies and advanced image guidance technology enable submillimeter accurate and noninvasive navigation for middle ear and lateral skull base surgery. BACKGROUND Surgery in the internal auditory canal and the petrous apex present a cognitive and motoric challenge for the surgeon. To date, image guidance rarely assists these procedures, mainly due to the lack of navigation solutions providing submillimeter accuracy associated with low cost in terms of invasiveness, radiation, and time. METHODS This study proposes an approach to clinically viable image guidance by using a combination of advanced image guidance technology and noninvasive registration strategies. Based on accuracy-optimized optical tracking hardware (accuracy: 0.05 ± 0.025 mm), 14 novel registration strategies were investigated. In human cadaveric temporal bone specimens n = 36 registration attempts per strategy were conducted. Target registration errors at 10 anatomical targets were measured. RESULTS The most accurate registration strategies were identified as paired-point-matching using eight landmarks located in the external auditory canal and middle ear and surface matching using combined surfaces of the middle ear, the external auditory canal and the mastoid cortex yielding target registration errors of 0.51 ± 0.28 mm and 0.36 ± 0.13 mm respectively. CONCLUSIONS This study demonstrates submillimeter TREs achieved with noninvasive, anatomy-based registration strategies in combination with advanced image guidance technology. Clinically viable LSB and ME navigation is realized without additional invasiveness, radiation and time associated with artificial fiducials. The appropriate registration strategy can be chosen by the surgeon depending on the pathology and surgical approach.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ear, Nose and Throat Disorders (ENT)

UniBE Contributor:

Caversaccio, Marco and Anschütz, Lukas Peter

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1531-7129

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Stefan Weder

Date Deposited:

23 Jan 2019 14:10

Last Modified:

23 Oct 2019 05:53

Publisher DOI:

10.1097/MAO.0000000000001993

PubMed ID:

30239434

BORIS DOI:

10.7892/boris.123707

URI:

https://boris.unibe.ch/id/eprint/123707

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