Max Jägersberg1, Jerermy Brodard2, Jimmy Qiu3, Alireza Mansouri4, Francesco Doglietto5, Fred Gentili4, Walter Kucharczyk3, Jean Fasel6, Karl Schaller2, Ivan Radovanovic4. 1. Division of Neurosurgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. Electronic address: max.jaegersberg@hcuge.ch. 2. Division of Neurosurgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. 3. Department of Medical Imaging, Toronto General Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada. 4. Division of Neurosurgery, Toronto Western Hospital, University Health Network and Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 5. Division of Neurosurgery, University of Brescia, Brescia, Italy. 6. Clinical Anatomy Research Group, Department of Cellular Physiology and Metabolism, University Medical Center, Geneva, Switzerland.
Abstract
OBJECTIVE: Quantitative comparison of minimally invasive and standard cranial approaches remains a methodologic challenge. The aim of this study was to apply a new digital, navigation-based method to quantify multiple parameters of the pterional, supraorbital, lateral supraorbital and mini-pterional approaches and to describe a target-specific maneuverability score. METHODS: Supraorbital, lateral supraorbital, mini-pterional, and standard pterional craniotomies were performed on 8 sides in 4 cadaver heads. The limits of superficial and deep exposure and surgical target points were registered with image-guidance (Medtronic Stealth). A custom software (Guided Therapeutics Eyes II Software [GTxEyesII]) calculated superficial and deep surface areas, working volumes, and target distances. Volumes were reconstructed digitally and visualized with GTxEyesII. Finally, we defined for each approach a target-specific maneuverability score based on surface exposure, target distance, target position, and anatomical obstacles. RESULTS: Surface exposure and volumes were significantly smaller for keyhole approaches compared with standard pterional craniotomy (P < 0.01). Maneuverability index scores showed the greatest values for standard pterional craniotomies, but nearly equally high scores could be achieved by one or several of the less-invasive approaches for most of the targets. CONCLUSIONS: The combination of a navigation-based measurement method with custom software (GTxEyesII) provides a powerful tool for visualization and quantification of surgical approaches. Compared with standard pterional craniotomy, alternative keyhole craniotomies offer comparable deep exposure with smaller working volumes and relatively high maneuverability for specific targets.
OBJECTIVE: Quantitative comparison of minimally invasive and standard cranial approaches remains a methodologic challenge. The aim of this study was to apply a new digital, navigation-based method to quantify multiple parameters of the pterional, supraorbital, lateral supraorbital and mini-pterional approaches and to describe a target-specific maneuverability score. METHODS: Supraorbital, lateral supraorbital, mini-pterional, and standard pterional craniotomies were performed on 8 sides in 4 cadaver heads. The limits of superficial and deep exposure and surgical target points were registered with image-guidance (Medtronic Stealth). A custom software (Guided Therapeutics Eyes II Software [GTxEyesII]) calculated superficial and deep surface areas, working volumes, and target distances. Volumes were reconstructed digitally and visualized with GTxEyesII. Finally, we defined for each approach a target-specific maneuverability score based on surface exposure, target distance, target position, and anatomical obstacles. RESULTS: Surface exposure and volumes were significantly smaller for keyhole approaches compared with standard pterional craniotomy (P < 0.01). Maneuverability index scores showed the greatest values for standard pterional craniotomies, but nearly equally high scores could be achieved by one or several of the less-invasive approaches for most of the targets. CONCLUSIONS: The combination of a navigation-based measurement method with custom software (GTxEyesII) provides a powerful tool for visualization and quantification of surgical approaches. Compared with standard pterional craniotomy, alternative keyhole craniotomies offer comparable deep exposure with smaller working volumes and relatively high maneuverability for specific targets.
Authors: Francesco Doglietto; Jimmy Qiu; Mayoorendra Ravichandiran; Ivan Radovanovic; Francesco Belotti; Anne Agur; Gelareh Zadeh; Marco Maria Fontanella; Walter Kucharczyk; Fred Gentili Journal: World J Methodol Date: 2017-12-26