title: Percutaneous access to the petrous apex in vitro using customized micro-stereotactic frames based on image-guided surgical technology.
abstract: Conclusion. Our study demonstrates (in cadavers) the ability to obtain a minimally invasive approach to access the petrous apex using patient-customized micro-stereotactic frames based on pre-intervention radiographic studies. Objective. To conduct in vitro studies to demonstrate the feasibility of percutaneous petrous apex access using customized, bone-mounted, micro-stereotactic frames. Methods. Cadaveric temporal bone specimens (n=10) were affixed with three bone-implanted fiducial markers. CT scans were obtained and used in planning, in reference to the fiducial markers, a straight transmastoid infralabyrinthine trajectory from the mastoid surface to the petrous apex without violating the basal turn of the cochlea or the carotid artery. A drill press was mounted on the customized frame and used to guide a 2 mm drill bit on the desired trajectory. The course of the drill bit and its relationship to surrounding vital anatomy (cochlea, carotid artery, facial nerve, and internal jugular vein) were determined by repeat CT scanning. Results. In 10 of 10 specimens, the drill bit trajectory was accurate with clearance (mean+/-standard deviation in mm) from the cochlea, facial nerve, carotid artery, and jugular vein of 3.43+/-1.57, 3.14+/-1.15, 4.57+/-1.52, and 6.05+/-2.98, respectively.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: George B
authors.initials: GB
authors.lastname: Wanna
authors.forename: Ramya
authors.initials: R
authors.lastname: Balachandran
authors.forename: Omid
authors.initials: O
authors.lastname: Majdani
authors.forename: Jason
authors.initials: J
authors.lastname: Mitchell
authors.forename: Robert F
authors.initials: RF
authors.lastname: Labadie
references.citation: Am J Otol. 1992 Nov;13(6):561-74
references.pmid: 1449185
references.citation: Laryngoscope. 1989 Sep;99(9):896-907
references.pmid: 2770381
references.citation: Ann Otol Rhinol Laryngol. 1988 Nov-Dec;97(6 Pt 1):594-8
references.pmid: 3202561
references.citation: Neurosurgery. 2001 Apr;48(4):810-6; discussion 816-7
references.pmid: 11322441
references.citation: Otol Neurotol. 2002 Jul;23(4):529-33
references.pmid: 12170157
references.citation: Otol Neurotol. 2007 Apr;28(3):325-9
references.pmid: 17414037
references.citation: Otolaryngol Clin North Am. 2007 Jun;40(3):479-519, viii
references.pmid: 17544693
references.citation: Laryngoscope. 2008 Jun;118(6):1031-9
references.pmid: 18401279
references.citation: Int J Comput Assist Radiol Surg. 2009 May;4(3):273-80
references.pmid: 20033593
references.citation: Neurosurgery. 2008 Oct;63(4 Suppl 2):326-32; discussion 332-3
references.pmid: 18981839
references.citation: Curr Opin Otolaryngol Head Neck Surg. 2005 Feb;13(1):27-31
references.pmid: 15654212
references.citation: Otolaryngol Clin North Am. 2007 Jun;40(3):611-24, x
references.pmid: 17544698
references.citation: Acta Neurochir (Wien). 2003 Sep;145(9):737-42; discussion 742
references.pmid: 14505098