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Image-Guided Systems in Temporal Bone and Skull Base Surgery
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
9 sections · 93 slides
Introduction
- Definition of image-guided surgery
- Automotive navigation as a model for IGS
- Otological applications and current uptake
- Sequence of steps in image-guided surgery
History
- Origins of image-guided surgery
- Cross-sectional imaging and early reference systems
- Evolution of marker localisation
- Registration as the link between patient and image
- Determinants of registration accuracy
Computed tomography and MRI
- Principle of computed tomography
- Reconstruction and Hounsfield units
- Computed tomography acquisition and reconstruction
- Modern acquisition techniques
- Raw voxel data compared with the processed image
- Accuracy limits imposed by voxel size
- Portable CT scanners and geometric fidelity
- Principle of magnetic resonance imaging
- Comparison of CT and MRI for surgical guidance
- Fusion of MRI to CT
Infrared and electromagnetic tracking
- Optical tracking by triangulation
- Triangulation in two dimensions
- Root mean square error of infrared tracking
- Maxwell distribution of optical tracking error
- Statistical distribution of tracking error
- Principle of electromagnetic tracking
- Advantages and limitations of EM tracking
- Reported error figures for tracking systems
Registration
- Definition and importance of registration
- Rigid point registration with increasing numbers of fiducials
- Choice of fiducial markers
- Surface registration technique
- Surface registration and the cantilever effect
- Targeting error after surface-based registration
- Target registration error and its sources
- Fiducial registration error
- Hierarchy of registration error terms
- Four practical steps to reduce registration error
- Centroid of the fiducial configuration
- Effect of fiducial spacing on the zone of accuracy
- Wide spacing of fiducial markers
- Effect of increasing the number of fiducial markers
- The FRE and TRE paradox
- Why fiducial registration error rises with more markers
- Dropping the worst-aligned fiducial
- Sanity check after registration
Commercial IGS systems
- Coordinate reference frames
- Fixation of the coordinate reference frame
- Market overview and the accuracy data problem
- Medtronic navigation platforms
- Registration options on the StealthStation
- Accuracy data for the StealthStation
- Brainlab navigation platforms
- Accuracy data for the Brainlab system
- Stryker systems and active infrared tracking
- The Q guidance system and its accuracy
- Electromagnetic systems in otolaryngology
- Evidence for EM navigation in neurotology
- The InstaTrak multicentre study
- Real-world accuracy compared with phantom studies
Evidence base
- State of the evidence for IGS
- Meta-analysis of complications with IGS
- Image guidance in transsphenoidal pituitary surgery
- Otological indications for IGS
- Familiarisation before critical need
Robotic surgery
- Trends pointing toward surgical robotics
- Engineering classification of surgical robots
- Robotic surgery in current otolaryngology practice
- Lessons from robotic neurosurgery
- Robotic access to the cochlea
- Investigational robot for cochlear access
- Robotic cochlear implant electrode insertion
- IotaMotion approval and first clinical trial
- Evolution of bone removal technique
- Bone-attached robot for the translabyrinthine approach
- Robotic mastoidectomy and labyrinthectomy
Summary
- Conclusion
- Key figures to remember
- Practical recommendations for the ear surgeon
- References
- References (continued)
- References (continued)
- References (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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