Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A.
Laryngoscope. 2021 Aug;131(8):1855-1862. doi: 10.1002/lary.29542. Epub 2021 Mar 29.
Patient-specific surgical simulation allows presurgical planning through three-dimensional (3D) visualization and virtual rehearsal. Virtual reality simulation for otologic surgery can be based on high-resolution cone-beam computed tomography (CBCT). This study aimed to evaluate clinicians' experience with patient-specific simulation of mastoid surgery.
Prospective, multi-institutional study. Preoperative temporal bone CBCT scans of patients undergoing cochlear implantation (CI) were retrospectively obtained. Automated processing and segmentation routines were used. Otologic surgeons performed a complete mastoidectomy with facial recess approach on the patient-specific virtual cases in the institution's temporal bone simulator. Participants completed surveys regarding the perceived accuracy and utility of the simulation.
Twenty-two clinical CBCTs were obtained. Four attending otologic surgeons and 5 otolaryngology trainees enrolled in the study. The mean number of simulations completed by each participant was 16.5 (range 3-22). "Overall experience" and "usefulness for presurgical planning" were rated as "good," "very good," or "excellent" in 84.6% and 71.6% of the simulations, respectively. In 10.7% of simulations, the surgeon reported to have gained a significantly greater understanding of the patient's anatomy compared to standard imaging. Participants were able to better appreciate subtle anatomic findings after using the simulator for 60.4% of cases. Variable CBCT acquisition quality was the most reported limitation.
Patient-specific simulation using preoperative CBCT is feasible and may provide valuable insights prior to otologic surgery. Establishing a CBCT acquisition protocol that allows for consistent segmentation will be essential for reliable surgical simulation.
3 Laryngoscope, 131:1855-1862, 2021.
患者特定的手术模拟通过三维（3D）可视化和虚拟演练实现术前规划。耳科学手术的虚拟现实模拟可以基于高分辨率锥形束 CT（CBCT）。本研究旨在评估临床医生对乳突手术的患者特定模拟的经验。
前瞻性、多机构研究。回顾性获取接受人工耳蜗植入（CI）的患者的颞骨 CBCT 扫描。使用自动处理和分割例程。耳科外科医生在机构的颞骨模拟器上对患者特定的虚拟病例进行完整的乳突切除术和面隐窝入路。参与者完成了关于模拟的感知准确性和实用性的调查。
共获得 22 例临床 CBCT。4 名主治耳科外科医生和 5 名耳鼻喉科受训者参加了这项研究。每位参与者完成的模拟平均数量为 16.5 次（范围 3-22）。“整体体验”和“对术前规划的有用性”在 84.6%和 71.6%的模拟中分别被评为“好”、“非常好”或“极好”。在 10.7%的模拟中，外科医生报告说与标准成像相比，对患者解剖结构的理解有了显著提高。在使用模拟器后，参与者能够更好地欣赏到 60.4%病例中的细微解剖发现。可变的 CBCT 采集质量是报告最多的限制因素。
使用术前 CBCT 的患者特定模拟是可行的，可以在耳科手术前提供有价值的见解。建立允许一致分割的 CBCT 采集协议对于可靠的手术模拟至关重要。
3 级喉镜，131：1855-1862，2021。
