Image guided surgery for petrous apex lesions

• Published in: Acta neurochirurgica Vol. 145; no. 9; pp. 737 - 742
• Main Authors: Van Havenbergh, T, Koekelkoren, E, De Ridder, D, Van De Heyning, P, Verlooy, J
• Format: Journal Article
• Language: English
• Published: Austria Springer Nature B.V 01.09.2003
• Subjects: Accuracy; Adult; Bone Diseases - diagnostic imaging; Bone Diseases - pathology; Bone Diseases - surgery; Child; Cholesterol; Granuloma, Foreign-Body - diagnostic imaging; Granuloma, Foreign-Body - pathology; Granuloma, Foreign-Body - surgery; Humans; Male; Neuronavigation; Petrous Bone - diagnostic imaging; Petrous Bone - pathology; Petrous Bone - surgery; Radiography; Reproducibility of Results; Surgery, Computer-Assisted
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-003-0054-x

To evaluate whether computer-assisted frameless stereotactic navigation in the temporal bone provides sufficient clinical application accuracy and thus a useful tool in temporal bone surgery. Two patients with petrous apex cholesterol granuloma were operated on by an epidural middle fossa approach using a Stealth/Medtronic trade mark neuronavigation system. Based on literature data optimal skin fiducial placement and registration methods were used. Intra-operative accuracy was checked using three precise anatomical landmarks. Drilling of the petrous apex bone was guided by neuronavigation. Postoperative Computed Tomography (CT) images were fused with the preoperative CT and planning. The application of image-guidance in temporal bone surgery causes no additional burden to the patient nor prolongs the operating time. The accuracy measured at the anatomical landmarks was under 2,0 mm. This is confirmed by evaluation of bone removal through image fusion of pre- and postoperative CT-scan. The clinical application of a neuronavigation system during petrous apex surgery can be regarded as useful. Using all available data on registration methods it seems possible to obtain intra-operative application accuracies of <2,0 mm. Additional cadaver work is being performed to support these data.