Computer-Aided Surgery in the Petrous Bone

• Published in: The Laryngoscope Vol. 109; no. 11; pp. 1793 - 1799
• Main Authors: Gunkel, Andreas R., Vogele, Michael, Martin, Arno, Bale, Reto J., Thumfart, Walter F., Freysinger, Wolfgang
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ John Wiley & Sons, Inc 01-11-1999; Wiley-Blackwell
• Subjects: assisted surgery; Biological and medical sciences; cholesteatoma; Cholesteatoma, Middle Ear - surgery; computer; Fistula - surgery; frameless stereotaxy; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Intraoperative Period; ISG Viewing Wand; Medical sciences; middle ear surgery; navigation; Petrous bone; Petrous Bone - surgery; Skull Base - surgery; Software; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the ear, the auditive nerve and the facial nerve; Technology. Biomaterials. Equipments; Therapy, Computer-Assisted - instrumentation; Therapy, Computer-Assisted - methods; three-dimensional; Vestibular Diseases - surgery; Guidance; Human; High resolution; Petrous bone; Treatment; Radiodiagnosis; Technology; Surgery; Medical imagery; Tridimensional image; Computerized axial tomography; Computer aid
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/00005537-199911000-00013

Objectives: We demonstrate that computer‐assisted frameless stereotactic navigation with the ISG/ELEKTA Viewing Wand system in the petrous bone is routinely possible with sufficient application accuracy.
Methods: High‐resolution computed tomography imaging is done with a dedicated structure attached to the mouthpiece of the Vogele‐Bale‐Hohner (VBH) head holder, an integral part of our intraoperative patient fixation. The patient image registration can be reliably performed before surgery in an unsterile environment with the registration structure of the mouthpiece. For intraoperative navigation either the position‐sensitive articulated arm or the optical three‐dimensional digitizer of the ISG/ELEKTA system is used.
Results: In the operations of the petrous bone performed so far, i.e., mastoidectomy, cholesteatoma surgery, and lateral skull base revision surgery, the clinical value of three‐dimensional navigation was clearly demonstrated with an application accuracy, constant throughout surgery, mostly limited only by the resolution of the computed tomography.