[Markerless patient registration. A new technique for image-guided surgery of the lateral base of the skull].

BACKGROUND: Markerless patient registration is a new procedure that may reduce logistical efforts and possibly also the radiation load on the patients prior to a computer-assisted intervention. Congruent surfaces, such as bone surfaces or skin surfaces, represented in a data set and in the surgical site, can be overlapped with the help of surface matching. Hitherto, these techniques were performed by using the periorbital and frontal skin of the face. The present clinical study assessed the usability of the auricle as a skin structure for markerless patient registration in lateral skull base surgery. PATIENTS AND METHODS: The periauricular precision of the navigation system SSN was investigated clinically in ten patients. Radiopaque registration markers in the periauricular region served as a target in order to evaluate the markerless registration method.
RESULTS: Exact patient registration failed in five cases due to temporary deformation of the auricle caused by the head support during CT imaging. An excellent patient registration (mean target registration error = 0.9+/-0.2 mm) was found as long as the auricles had not been temporarily deformed during CT imaging.
CONCLUSION: Laser-scan registration of the auricle reduces logistics in image-guided lateral skull base surgery. The problem of temporary deformation of the auricle during CT imaging might be solved by an appropriate opening in the head support at the level of the auricles.