Preoperative planning and intraoperative navigation in skull base surgery

• Published in: Journal of cranio-maxillo-facial surgery 1998-08, Vol.26 (4), p.220-225
• Main Authors: Hassfeld, Stefan, Zöller, Joachim, Albert, Friedrich K., Wirtz, Christian R., Knauth, Michael, Mühling, Joachim
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Computer Simulation; Computer Systems; Dentistry; Electronics, Medical - instrumentation; Equipment Design; Humans; Image Processing, Computer-Assisted; Infrared Rays; Intraoperative Care; Magnetic Resonance Imaging; Medical sciences; Meningioma - surgery; Middle Aged; Nasal Bone - surgery; Neoplasm Invasiveness; Nose Neoplasms - surgery; Online Systems; Orbital Neoplasms - surgery; Patient Care Planning; Photography - instrumentation; Skull Base - surgery; Skull Base Neoplasms - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Technology. Biomaterials. Equipments; Therapy, Computer-Assisted - instrumentation; Tomography, X-Ray Computed; User-Computer Interface
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/S1010-5182(98)80017-6

Experience with the commercially available, 3-D navigation systems Viewing Wand (ISG, Mississauga, Ontario, Canada) and SPOCS (Aesculap, Germany) in skull base surgery is presented. Having meanwhile been tested in over 60 clinical trials, the systems achieved an accuracy of ≤2.7 mm which, at the moment, we deem sufficiently acceptable to proceed with their clinical evaluation. There was no difference in intraoperative accuracy between the mechanical and the optical navigation systems. The systems proved to be very helpful in identifying the extent of the tumours and in visualizing the proximity of vital structures. 3-D-planning, simulation and intraoperative navigation especially facilitates surgery in anatomically complicated situations, without risk of damaging neighbouring structures. The SPOCS (Surgical Planning and Orientation Computer System) revealed a considerably improved flexibility in handling and a better integration into the surgical procedure in comparison with the relatively inflexible and space-demanding Viewing Wand arm. Especially, the ‘offset’ function of the SPOCS offers the possibility of a virtual elongation of the instrument and thus, in combination with the on-line visualization of the corresponding images, of a ‘look ahead’ operation. By using computer-assisted simulation and navigation systems, we can expect quality improvement and risk reduction. More extensive and radical interventions seem possible.