Neuronavigation in Endonasal Pituitary and Skull Base Surgery Using an Autoregistration Mask without Head Fixation: An Assessment of Accuracy and Practicality

 

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Abstract

Background Intraoperative navigation is an important tool used during endonasal surgery, which typically requires rigid head fixation. Herein we describe a navigational technique using an autoregistration mask without head fixation.

Material and Methods Prospective evaluation of a surface autoregistration mask used without rigid head fixation in 12 consecutive endonasal endoscopic skull base procedures was performed with patients positioned in a horseshoe head holder. We assessed the accuracy by recording the surface registration error (SRE) and target registration error (TRE). We also noted the time required for installation and the occurrence of system failure. The system's accuracy was validated using a deep target simultaneously viewed with endoscopic.

Results In 12 consecutive endonasal cases performed by a neurosurgeon and ENT team, pathologies included pituitary macroadenomas (9), chordoma (1), craniopharyngioma (1), and sinonasal melanoma (1). Median time required for the registration and accuracy verification was 84 seconds (interval 64 to 129 seconds). The mask stayed on the patient throughout the procedure. The mean SRE was 0.8 mm (interval 0.6 to 0.9 mm). The mean TRE was 0.9 ± 0.7 mm and 1.0 ± 0.8 mm measured respectively at the beginning and end of the case. In every case, the system was judged accurate by the surgical team using the sphenoid keel or an intrasphenoidal bony septation as a deep target for internal validation. No system failure occurred during these 12 cases.

Conclusion A facial surface autoregistration mask maintained in place throughout surgery without rigid head fixation allows excellent operational accuracy in endonasal pituitary and skull base surgery. This navigation system is practical, reliable, and noninvasive.

• References

• 1 Wise SK, DelGaudio JM. Computer-aided surgery of the paranasal sinuses and skull base. Expert Rev Med Devices 2005; 2: 395-408
  CrossrefPubMedGoogle Scholar
• 2 Grauvogel TD, Soteriou E, Metzger MC, Berlis A, Maier W. Influence of different registration modalities on navigation accuracy in ear, nose, and throat surgery depending on the surgical field. Laryngoscope 2010; 120: 881-888
  PubMedGoogle Scholar
• 3 Eggers G, Mühling J, Marmulla R. Image-to-patient registration techniques in head surgery. Int J Oral Maxillofac Surg 2006; 35: 1081-1095
  CrossrefPubMedGoogle Scholar
• 4 Mitsui T, Fujii M, Tsuzaka M, Hayashi Y, Asahina Y, Wakabayashi T. Skin shift and its effect on navigation accuracy in image-guided neurosurgery. Radiological Phys Technol 2011; 4: 37-42
  PubMedGoogle Scholar
• 5 Makiese O, Pillai P, Salma A, Sammet S, Ammirati M. Accuracy validation in a cadaver model of cranial neuronavigation using a surface autoregistration mask. Neurosurgery 2010; 67 (3, Suppl Operative) ons85-ons90 , discussion ons90
  CrossrefPubMedGoogle Scholar
• 6 Casiano RR, Numa Jr WA. Efficacy of computed tomographic image-guided endoscopic sinus surgery in residency training programs. Laryngoscope 2000; 110: 1277-1282
  CrossrefPubMedGoogle Scholar
• 7 Cartellieri M, Vorbeck F. Endoscopic sinus surgery using intraoperative computed tomography imaging for updating a three-dimensional navigation system. Laryngoscope 2000; 110 (2 Pt 1) 292-296
  CrossrefPubMedGoogle Scholar
• 8 Al-Mefty O, Pravdenkova S, Gragnaniello C. A technical note on endonasal combined microscopic endoscopic with free head navigation technique of removal of pituitary adenomas. Neurosurg Rev 2010; 33: 243-248 , discussion 248–249
  CrossrefPubMedGoogle Scholar
• 9 Watanabe Y, Fujii M, Hayashi Y , et al. Evaluation of errors influencing accuracy in image-guided neurosurgery. Radiological Phys Technol 2009; 2: 120-125
  PubMedGoogle Scholar
• 10 Schlaier J, Warnat J, Brawanski A. Registration accuracy and practicability of laser-directed surface matching. Comput Aided Surg 2002; 7: 284-290
  CrossrefPubMedGoogle Scholar
• 11 Caversaccio M, Nolte LP, Häusler R. Present state and future perspectives of computer aided surgery in the field of ENT and skull base. Acta Otorhinolaryngol Belg 2002; 56: 51-59
  PubMedGoogle Scholar
• 12 Snyderman C, Zimmer LA, Kassam A. Sources of registration error with image guidance systems during endoscopic anterior cranial base surgery. Otolaryngol Head Neck Surg 2004; 131: 145-149
  CrossrefPubMedGoogle Scholar
• 13 Steinmeier R, Rachinger J, Kaus M, Ganslandt O, Huk W, Fahlbusch R. Factors influencing the application accuracy of neuronavigation systems. Stereotact Funct Neurosurg 2000; 75: 188-202
  CrossrefPubMedGoogle Scholar
• 14 Greenfield JP, Howard BM, Huang C, Boockvar JA. Endoscopic endonasal transsphenoidal surgery using a skull reference array and laser surface scanning. Minim Invasive Neurosurg 2008; 51: 244-246
  Article in Thieme ConnectPubMedGoogle Scholar
• 15 Eliashar R, Sichel JY, Gross M , et al. Image guided navigation system-a new technology for complex endoscopic endonasal surgery. Postgrad Med J 2003; 79: 686-690
  PubMedGoogle Scholar