title: Surgical instrument tracking optimizes trans-sphenoidal endoscopic treatment of petrous apex cholesterol granuloma.
abstract: During endoscopic trans-sphenoidal treatment of petrous apex cholesterol granuloma, the challenge for the surgeon is to drill the posterior wall of the sphenoid sinus to reach the lesion while attempting to avoid the internal carotid artery (ICA). A refined neuronavigation technique is presented that diminishes bonework needed for exposure and marsupialization, and simultaneously minimizes risks of accidental harm to the ICA. The technique utilizes real-time intraoperative instrument tracking of a drill, enabling safe creation of a direct canal toward the cyst just medial to the paraclival ICA and of a curette for entirely image-guided marsupialization of the cyst's deep areas through the canal.
authors.affiliation: Department of Neurosurgery, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands. e.h.j.voormolen@umcutrecht.nl
authors.forename: Eduard H
authors.initials: EH
authors.lastname: Voormolen
authors.forename: Sebastien
authors.initials: S
authors.lastname: Froelich
authors.forename: Peter A
authors.initials: PA
authors.lastname: Woerdeman
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Berkelbach van der Sprenkel
authors.forename: Weibel W
authors.initials: WW
authors.lastname: Braunius
authors.forename: Luca
authors.initials: L
authors.lastname: Regli
mesh_terms: D000328:Adult; D001845:Bone Cysts / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D020212:Carotid Artery Injuries / Q000517:prevention & control; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D006099:Granuloma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D038361:Neuronavigation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D010579:Petrous Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed