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  • Intraoperative Immersive Three-Dimensional Neuronavigation for Skull Base Surgery and Frontal Sinus Dissection

    Final Number:

    Joshua Ryan Zeiger BA; Alfred MC Iloreta MD; Anthony Del Signore MD; Holly Oemke BA; Anthony Costa; Satish Govindaraj MD; Raj K Shrivastava MD; Joshua B. Bederson MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Endoscopic endonasal approaches provide access to the anterior skull base and paranasal sinuses. Identification of anatomic landmarks can be challenging during these cases. Neuronavigation systems assist with orientation, but they require the surgeon to mentally match three-dimensional (3D) views with two-dimensional (2D) radiology studies. This study presents the initial experience with a novel technology (EndoSNAP) that provides intraoperative navigation using manually augmented, 3D reconstructions of patient anatomy for endoscopic surgery.

    Methods: Anterior skull base and complex paranasal sinus cases were identified. Data from pre-operative CT and MRI scans were layered to create 3D models of patient anatomy. Using technology developed by Surgical Theater, these reconstructions were manipulated to highlight particular anatomic regions of interest with unique colors and labels. Attending neurosurgeons and otolaryngologists oversaw model production. The reconstructions were linked with navigational technology during endoscopic surgery. The endoscope itself was used as the navigational probe for the fiducial coordinate system. This produced a dynamic image of the reconstruction that was displayed alongside a matching camera view produced by the endoscope. These two views could be overlaid to provide an immersive, augmented reality image of the patient’s anatomy.

    Results: 40 cases were identified. 31 cases were tumors of the anterior skull base or sinonasal cavity: the most common lesions were pituitary tumors (15). The 9 non-tumor cases included frontal sinus dissections for sinusitis and CSF leak repairs. It took approximately 30 to 45 minutes to create each reconstruction. Anatomic structures were chosen for enhancement based on particular patient anatomy and pathology. The most commonly isolated structures were tumors, internal carotid arteries, and elements of the visual pathway. These cues provided the surgeon with anatomic orientation.

    Conclusions: The EndoSNAP is a promising new tool for guidance during endoscopic surgery. Future studies will evaluate the accuracy of the reconstructions and their effects on complication rates and operative time.

    Patient Care: Enhanced navigational systems may lead to safer and shorter procedures for patients undergoing endoscopic surgeries for skull base or paranasal sinus pathology.

    Learning Objectives: By the conclusion of the session, participants should be able to: 1) Describe a novel navigational tool for endoscopy surgery of the anterior skull base and paranasal sinuses. 2) Describe the initial experience with this tool with 40 patients at an academic medical center. 3) Describe how augmented reality technology can assist surgeons performing endoscopic procedures.


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