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Minimally invasive multiport surgery of the lateral skull base

: Stenin, Igor; Hansen, Stefan; Becker, Meike; Sakas, Georgios; Fellner, Dieter W.; Klenzner, Thomas; Schipper, Jörg

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BioMed research international 2014 (2014), Art. 379295, 7 pp.
ISSN: 2314-6133
ISSN: 2314-6141
Journal Article, Electronic Publication
Fraunhofer IGD ()
Operation planning; Minimally Invasive Surgery; computer assisted surgery; medical simulation; medical sciences; Business Field: Visual decision support; Research Area: (Interactive) Simulation (SIM); Research Area: Modeling (MOD); Forschungsgruppe Semantic Models, Immersive Systems (SMIS); Forschungsgruppe Medical Computing (MECO)

Objective: Minimally invasive procedures minimize iatrogenic tissue damage and lead to a lower complication rate and high patient satisfaction. To date only experimental minimally invasive single-port approaches to the lateral skull base have been attempted. The aim of this study was to verify the feasibility of a minimally invasive multiport approach for advanced manipulation capability and visual control and develop a software tool for preoperative planning.
Methods: Anatomical 3D models were extracted from twenty regular temporal bone CT scans. Collision-free trajectories, targeting the internal auditory canal, round window, and petrous apex, were simulated with a specially designed planning software tool. A set of three collision-free trajectories was selected by skull base surgeons concerning the maximization of the distance to critical structures and the angles between the trajectories.
Results: A set of three collision-free trajectories could be successfully simulated to the three targets in each temporal bone model without violating critical anatomical structures.
Conclusion: A minimally invasive multiport approach to the lateral skull base is feasible. The developed software is the first step for preoperative planning. Further studies will focus on cadaveric and clinical translation.