title: Minimally invasive multiport surgery of the lateral skull base.
abstract: OBJECTIVE
  Minimally invasive procedures minimize iatrogenic tissue damage and lead to a lower complication rate and high patient satisfaction. To date only experimental minimally invasive single-port approaches to the lateral skull base have been attempted. The aim of this study was to verify the feasibility of a minimally invasive multiport approach for advanced manipulation capability and visual control and develop a software tool for preoperative planning.
  
  
  METHODS
  Anatomical 3D models were extracted from twenty regular temporal bone CT scans. Collision-free trajectories, targeting the internal auditory canal, round window, and petrous apex, were simulated with a specially designed planning software tool. A set of three collision-free trajectories was selected by skull base surgeons concerning the maximization of the distance to critical structures and the angles between the trajectories.
  
  
  RESULTS
  A set of three collision-free trajectories could be successfully simulated to the three targets in each temporal bone model without violating critical anatomical structures.
  
  
  CONCLUSIONS
  A minimally invasive multiport approach to the lateral skull base is feasible. The developed software is the first step for preoperative planning. Further studies will focus on cadaveric and clinical translation.
authors.affiliation: Department of Otorhinolaryngology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany.
authors.forename: Igor
authors.initials: I
authors.lastname: Stenin
authors.affiliation: Department of Otorhinolaryngology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hansen
authors.affiliation: Interactive Graphics Systems Group, Technical University Darmstadt, 64283 Darmstadt, Germany.
authors.forename: Meike
authors.initials: M
authors.lastname: Becker
authors.affiliation: Interactive Graphics Systems Group, Technical University Darmstadt, 64283 Darmstadt, Germany.
authors.forename: Georgios
authors.initials: G
authors.lastname: Sakas
authors.affiliation: Interactive Graphics Systems Group, Technical University Darmstadt, 64283 Darmstadt, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Fellner
authors.affiliation: Department of Otorhinolaryngology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Klenzner
authors.affiliation: Department of Otorhinolaryngology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Schipper
mesh_terms: D002102:Cadaver; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008953:Models, Anatomic; D019291:Skull Base / Q000601:surgery*; D012984:Software; D013701:Temporal Bone / Q000601:surgery
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