[Integration of the functional signal of intraoperative EMG of the facial nerve in to navigation model for surgery of the petrous bone].
PROBLEM DEFINITION: The goal of this work is the integration of the information of the intraoperative EMG monitoring of the facial nerve into the radiological data of the petrous bone. The following hypotheses are to be examined: (I) the N. VII can be determined intraoperatively with a high reliability by the stimulation-probe. A computer program is able to discriminate true-positive EMG signals from false-positive artifacts. (II) The course of the facial nerve can be registered in a three-dimensional area by EMG signals at a nerve model in the lab test. The individual items of the nerve can be combined into a route model. The route model can be integrated into the data of digital volume tomography (DVT).


METHODS
(I) Intraoperative EMG signals of the facial nerve were classified at 128 measurements by an automatic software. The results were correlated with the actual intraoperative situation. (II) The nerve phantom was designed and a DVT data set was provided. Phantom was registered with a navigation system (Karl Storz NPU, Tuttlingen, Germany). The stimulation probe of the EMG-system was tracked by the navigation system. The navigation system was extended by a processing unit (MiMed, Technische Universität München, Germany). Thus the classified EMG parameters of the facial route can be received, processed and be generated to a model of the facial nerve route. The operability was examined at 120 (10 x 12) measuring points.


RESULTS
The evaluation of the examined algorithm for classification EMG-signals of the facial nerve resulted as correct in all measuring events. In all 10 attempts it succeeded to visualize the nerve route as three-dimensional model. The different sizes of the individual measuring points reflect the appropriate values of Istim and UEMG correctly.


CONCLUSIONS
This work proves the feasibility of an automatic classification of an intraoperative EMG signal of the facial nerve by a processing unit. Furthermore the work shows the feasibility of tracking of the position of the stimulation probe and its integration into amodel of the route of the facial nerve (e. g. DVT). The rediability, with which the position of the nerve can be seized by the stimulation probe, is also included into the resulting route model.
Strauss
G
G
Klinik und Poliklinik für HNO-Heilkunde/Plastische Operationen, Universität Leipzig. Gero.Strauss@medizin.uni-leipzig.de
Strauss
M
M
Lüders
C
C
Stopp
S
S
Shi
J
J
Dietz
A
A
Lüth
T
T
D000200:Action Potentials / Q000502:physiology; D000465:Algorithms; D016477:Artifacts; D004558:Electric Stimulation / Q000295:instrumentation; D004576:Electromyography / Q000295:instrumentation*; D004867:Equipment Design; D005152:Facial Muscles / Q000294:innervation; D005154:Facial Nerve / Q000503:physiopathology*; D005240:Feasibility Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D021621:Imaging, Three-Dimensional / Q000295:instrumentation*; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008416:Mastoid / Q000601:surgery*; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D010579:Petrous Bone / Q000601:surgery*; D019047:Phantoms, Imaging; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*; D012984:Software; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*