Image guided surgery for petrous apex lesions.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
D000328:Adult; D001847:Bone Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002648:Child; D002784:Cholesterol; D015745:Granuloma, Foreign-Body / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D038361:Neuronavigation; D010579:Petrous Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted
D002784:Cholesterol