Department of Neurosurgery and Neurology, Rudolf Magnus Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
Oper Neurosurg (Hagerstown). 2020 Jan 1;18(1):83-91. doi: 10.1093/ons/opz064.
A combined drill distance control and virtual drilling image guidance feedback method was developed.
To investigate whether first-time usage of the proposed method, during anterior petrosectomy (AP), improves surgical orientation and surgical performance. The accuracy of virtual drilling and the clinical practicability of the method were also investigated.
In a simulated surgical setting using human cadavers, a trial was conducted with 5 expert skull base surgeons from 3 different hospitals. They performed 10 AP approaches, using either the feedback method or standard image guidance. Damage to critical structures was assessed. Operating time, drill cavity sizes, and proximity of postoperative drill cavities to the cochlea and the acoustic meatus, were measured. Questionnaires were obtained postoperatively. Errors in the virtual drill cavities as compared with actual postoperative cavities were calculated. In a clinical setup, the method was used during AP.
Surgeons rated their intraoperative orientation significantly better with the feedback method compared with standard image guidance. During the cadaver trial, the cochlea was harmed on 1 occasion in the control group, while surgeons drilled closer to the cochlea and meatus without injuring them in the group using feedback. Virtual drilling under- and overestimation errors were 2.2 ± 0.2 and -3.0 ± 0.6 mm on average. The method functioned properly during the clinical setup.
The proposed feedback method improves orientation and surgical performance in an experimental setting. Errors in virtual drilling reflect spatial errors of the image guidance system. The feedback method is clinically practicable during AP.
开发了一种联合钻头距离控制和虚拟钻孔图像引导反馈方法。
研究在经前岩骨切除术 (AP) 中首次使用该方法是否可以改善手术方向和手术效果。还研究了虚拟钻孔的准确性和该方法的临床实用性。
在使用人体尸体的模拟手术环境中，来自 3 家不同医院的 5 名专家颅底外科医生进行了一项试验。他们使用反馈方法或标准图像引导进行了 10 次 AP 入路。评估了对关键结构的损伤。测量手术时间、钻头腔的大小以及术后钻头腔与耳蜗和听道的接近程度。术后获得了调查问卷。计算了虚拟钻头腔与实际术后钻头腔之间的误差。在临床设置中，该方法用于 AP。
与标准图像引导相比，外科医生使用反馈方法时，其术中方向感明显更好。在尸体试验中，对照组有 1 次损伤了耳蜗，而使用反馈的组则更靠近耳蜗和耳道钻孔而没有损伤它们。虚拟钻孔的低估和高估误差平均为 2.2 ± 0.2 和-3.0 ± 0.6 毫米。该方法在临床设置中运行良好。
在实验环境中，所提出的反馈方法可改善方向感和手术效果。虚拟钻孔的误差反映了图像引导系统的空间误差。在 AP 期间，反馈方法具有临床实用性。
