title: Minimally invasive, multi-port approach to the lateral skull base: a first in vitro evaluation.
abstract: OBJECTIVE
  The aim of the study was to validate a minimally invasive, multi-port approach to the internal auditory canal at the lateral skull base on a cadaver specimen.
  
  
  METHODS
  Fiducials and a custom baseplate were fixed on a cadaver skull, and a computed tomography image was acquired. Three trajectories from the mastoid surface to the internal auditory canal were computed with a custom planning tool. A self-developed positioning system with a drill guide was attached to the baseplate. After referencing on a high precision coordinate measuring machine, the drill guide was aligned according to the planned trajectories. Drilling of three trajectories was performed with a medical stainless steel drill bit.
  
  
  RESULTS
  The process of planning and drilling three trajectories to the internal auditory canal with the presented workflow and tools was successful. The mean drilling error of the system (Euclidian distance between the planned trajectory and centerline of the actual drilled canal) was [Formula: see text] mm at the entry point and [Formula: see text] mm at the target. The inaccuracy of the drill process itself and its physical limitations were identified as the main contributing factors.
  
  
  CONCLUSIONS
  The presented system allows the planning and drilling of multiple minimally invasive canals at the lateral skull base. Further studies are required to reduce the drilling error and evaluate the clinical application of the system.
authors.affiliation: Department of Otorhinolaryngology, University Hospital Düsseldorf, 40225, Düsseldorf, Germany. igor.stenin@med.uni-duesseldorf.de.
authors.forename: Igor
authors.initials: I
authors.lastname: Stenin
authors.affiliation: Department of Otorhinolaryngology, University Hospital Essen, Essen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hansen
authors.affiliation: Laboratory for Machine Tools and Production Engineering, RWTH Aachen University, Aachen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Nau-Hermes
authors.affiliation: Interactive Graphics Systems Group, Technical University Darmstadt, Darmstadt, Germany.
authors.forename: W
authors.initials: W
authors.lastname: El-Hakimi
authors.affiliation: Interactive Graphics Systems Group, Technical University Darmstadt, Darmstadt, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Becker
authors.affiliation: Laboratory for Machine Tools and Production Engineering, RWTH Aachen University, Aachen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Bredemann
authors.affiliation: Department of Otorhinolaryngology, University Hospital Düsseldorf, 40225, Düsseldorf, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Kristin
authors.affiliation: Department of Otorhinolaryngology, University Hospital Düsseldorf, 40225, Düsseldorf, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Klenzner
authors.affiliation: Department of Otorhinolaryngology, University Hospital Düsseldorf, 40225, Düsseldorf, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Schipper
mesh_terms: D000465:Algorithms; D016477:Artifacts; D002102:Cadaver; D019929:Cochlear Implantation / Q000379:methods*; D006801:Humans; D008416:Mastoid / Q000000981:diagnostic imaging / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D000071069:Multiple Chronic Conditions; D056888:Patient Positioning; D015203:Reproducibility of Results; D019291:Skull Base / Q000000981:diagnostic imaging / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D057188:Workflow
keywords: Computer-assisted surgery; Minimally invasive; Otology; Skull base surgery