Radiographic anatomy of the infracochlear approach to the petrous apex for computer-assisted surgery
Identifieur interne : 001703 ( Pmc/Curation ); précédent : 001702; suivant : 001704Radiographic anatomy of the infracochlear approach to the petrous apex for computer-assisted surgery
Auteurs : Randal Leung [États-Unis] ; Ravi N. Samy [États-Unis] ; James L. Leach [États-Unis] ; Shanmugam Murugappan [États-Unis] ; Don Stredney [États-Unis] ; Gregory WietSource :
- Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology [ 1531-7129 ] ; 2010.
Abstract
1) To define the surgical anatomy and dimensions of the infracochlear approach to the petrous apex through use of high resolution computed tomography (HRCT) 2) use of digitized images of cadaveric temporal bones for computer simulation of infracochlear access using the OSC/OSU temporal bone simulator
The petrous apex is a surgically challenging area to access. Many routes have been described and used successfully in clinical practice. However, these routes have not been defined with the aim of application in computer-assisted surgery. The infracochlear approach, due to its access via a transcanal route, affords the opportunity for its potential application in minimally invasive computer-assisted surgery.
High resolution CT (HRCT) scans were performed on 102 cadaveric skulls (total of 204 temporal bones). Standard measurements were taken using an open source Picture Archiving and Communication System (PACS) software of the maximum height, width, and depth of the infracochlear approach. In addition, the maximum diameter of a circular fenestration that could be created in the infracochlear space without breaching the basal turn of the cochlea, internal carotid artery, or the jugular bulb was used to simulate a drill path. In addition, five temporal bone specimens (3 left, 2 right) underwent HRCT with the digitized images being used to create simulated temporal bones for infracochlear surgical access; the transcanal infracochlear approach was then performed by the same surgeon on the cadaveric bone.
The mean height, width and depth of the infracochlear space in temporal bones with non-pneumatized petrous apices were 7.2 +/− 0.4mm, 9.4 +/− 0.8mm and 17.5 +/− 1.0mm respectively. Corresponding dimensions in pneumatized petrous apices were 7.6 +/− 0.4mm, 10.1+/− 1.1 and 18.6 +/−0.8mm. The mean diameter of the circular fenestra in the non-pneumatized petrous apices was 5.1 +/− 0.4mm compared to 5.7 +/− 0.6mm in pneumatized petrous pieces. This was statistically significant (Unpaired t-Test, p value = 0.04). The time to perform a simulated infracochlear approach to the petrous apex ranged from 3.1 – 12.6 minutes (mean: 6.1 minutes). The time to perform the same approach on the cadaveric bone ranged from 4.32 – 14.1 minutes (mean 9.3 minutes).
Temporal bones with pneumatized petrous apices have an overall larger infracochlear space. The mean diameter of a circular infracochlear path that would avoid damage to vital structures was sufficiently large in both pneumatized and non-pneumatized petrous apices to have a potential application as a safe approach in computer-assisted surgery. Such an application is feasible with mating of a robotic system with CT or MRI guided imagery, which is the next phase of this study.
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DOI: 10.1097/MAO.0b013e3181c99524
PubMed: 20084044
PubMed Central: 3864006
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Gregory Wiet<affiliation><nlm:aff id="A4">Ohio State University, Nationwide Children's Hospital</nlm:aff><wicri:noCountry code="subfield">Nationwide Children's Hospital</wicri:noCountry></affiliation>Le document en format XML
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Samy</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Otolaryngology / Head and Neck Surgery, University of Cincinnati / Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Ohio</region></placeName><wicri:cityArea>Department of Otolaryngology / Head and Neck Surgery, University of Cincinnati / Cincinnati Children's Hospital Medical Center, Cincinnati</wicri:cityArea></affiliation></author><author><name sortKey="Leach, James L" sort="Leach, James L" uniqKey="Leach J" first="James L." last="Leach">James L. Leach</name><affiliation wicri:level="2"><nlm:aff id="A2">Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Ohio</region></placeName><wicri:cityArea>Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati</wicri:cityArea></affiliation></author><author><name sortKey="Murugappan, Shanmugam" sort="Murugappan, Shanmugam" uniqKey="Murugappan S" first="Shanmugam" last="Murugappan">Shanmugam Murugappan</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Otolaryngology / Head and Neck Surgery, University of Cincinnati / Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Ohio</region></placeName><wicri:cityArea>Department of Otolaryngology / Head and Neck Surgery, University of Cincinnati / Cincinnati Children's Hospital Medical Center, Cincinnati</wicri:cityArea></affiliation></author><author><name sortKey="Stredney, Don" sort="Stredney, Don" uniqKey="Stredney D" first="Don" last="Stredney">Don Stredney</name><affiliation wicri:level="2"><nlm:aff id="A3">Ohio Supercomputer Center, Columbus, Ohio</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Ohio</region></placeName><wicri:cityArea>Ohio Supercomputer Center, Columbus</wicri:cityArea></affiliation></author><author><name sortKey="Wiet, Gregory" sort="Wiet, Gregory" uniqKey="Wiet G" first="Gregory" last="Wiet">Gregory Wiet</name><affiliation><nlm:aff id="A4">Ohio State University, Nationwide Children's Hospital</nlm:aff><wicri:noCountry code="subfield">Nationwide Children's Hospital</wicri:noCountry></affiliation></author></analytic><series><title level="j">Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology</title><idno type="ISSN">1531-7129</idno><idno type="eISSN">1537-4505</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title><p id="P1">1) To define the surgical anatomy and dimensions of the infracochlear approach to the petrous apex through use of high resolution computed tomography (HRCT) 2) use of digitized images of cadaveric temporal bones for computer simulation of infracochlear access using the OSC/OSU temporal bone simulator</p></sec><sec id="S2"><title>Background</title><p id="P2">The petrous apex is a surgically challenging area to access. Many routes have been described and used successfully in clinical practice. However, these routes have not been defined with the aim of application in computer-assisted surgery. The infracochlear approach, due to its access via a transcanal route, affords the opportunity for its potential application in minimally invasive computer-assisted surgery.</p></sec><sec id="S3"><title>Methods</title><p id="P3">High resolution CT (HRCT) scans were performed on 102 cadaveric skulls (total of 204 temporal bones). Standard measurements were taken using an open source Picture Archiving and Communication System (PACS) software of the maximum height, width, and depth of the infracochlear approach. In addition, the maximum diameter of a circular fenestration that could be created in the infracochlear space without breaching the basal turn of the cochlea, internal carotid artery, or the jugular bulb was used to simulate a drill path. In addition, five temporal bone specimens (3 left, 2 right) underwent HRCT with the digitized images being used to create simulated temporal bones for infracochlear surgical access; the transcanal infracochlear approach was then performed by the same surgeon on the cadaveric bone.</p></sec><sec id="S4"><title>Results</title><p id="P4">The mean height, width and depth of the infracochlear space in temporal bones with non-pneumatized petrous apices were 7.2 +/− 0.4mm, 9.4 +/− 0.8mm and 17.5 +/− 1.0mm respectively. Corresponding dimensions in pneumatized petrous apices were 7.6 +/− 0.4mm, 10.1+/− 1.1 and 18.6 +/−0.8mm. The mean diameter of the circular fenestra in the non-pneumatized petrous apices was 5.1 +/− 0.4mm compared to 5.7 +/− 0.6mm in pneumatized petrous pieces. This was statistically significant (Unpaired t-Test, p value = 0.04). The time to perform a simulated infracochlear approach to the petrous apex ranged from 3.1 – 12.6 minutes (mean: 6.1 minutes). The time to perform the same approach on the cadaveric bone ranged from 4.32 – 14.1 minutes (mean 9.3 minutes).</p></sec><sec id="S5"><title>Conclusions</title><p id="P5">Temporal bones with pneumatized petrous apices have an overall larger infracochlear space. The mean diameter of a circular infracochlear path that would avoid damage to vital structures was sufficiently large in both pneumatized and non-pneumatized petrous apices to have a potential application as a safe approach in computer-assisted surgery. Such an application is feasible with mating of a robotic system with CT or MRI guided imagery, which is the next phase of this study.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">100961504</journal-id><journal-id journal-id-type="pubmed-jr-id">22035</journal-id><journal-id journal-id-type="nlm-ta">Otol Neurotol</journal-id><journal-id journal-id-type="iso-abbrev">Otol. Neurotol.</journal-id><journal-title-group><journal-title>Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology</journal-title></journal-title-group><issn pub-type="ppub">1531-7129</issn><issn pub-type="epub">1537-4505</issn></journal-meta><article-meta><article-id pub-id-type="pmid">20084044</article-id><article-id pub-id-type="pmc">3864006</article-id><article-id pub-id-type="doi">10.1097/MAO.0b013e3181c99524</article-id><article-id pub-id-type="manuscript">NIHMS172888</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Radiographic anatomy of the infracochlear approach to the petrous apex for computer-assisted surgery</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Leung</surname><given-names>Randal</given-names></name><degrees>MBBS, FRACS</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Samy</surname><given-names>Ravi N.</given-names></name><degrees>MD, FACS</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Leach</surname><given-names>James L.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Murugappan</surname><given-names>Shanmugam</given-names></name><degrees>Ph.D.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Stredney</surname><given-names>Don</given-names></name><degrees>M.A.</degrees><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Wiet</surname><given-names>Gregory</given-names></name><degrees>M.D.</degrees><xref ref-type="aff" rid="A4">4</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Otolaryngology / Head and Neck Surgery, University of Cincinnati / Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio</aff><aff id="A2"><label>2</label>Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio</aff><aff id="A3"><label>3</label>Ohio Supercomputer Center, Columbus, Ohio</aff><aff id="A4"><label>4</label>Ohio State University, Nationwide Children's Hospital</aff><author-notes><corresp id="CR1">Corresponding author Ravi N. Samy, M.D., F.A.C.S. Department of Otolaryngology / Head and Neck Surgery University of Cincinnati / Cincinnati Children's Hospital 231 Albert Sabin Way Cincinnati, OH 45267-0528 <email>Ravi.Samy@UC.edu</email> 513-558-4143</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>27</day><month>11</month><year>2013</year></pub-date><pub-date pub-type="ppub"><month>4</month><year>2010</year></pub-date><pub-date pub-type="pmc-release"><day>16</day><month>12</month><year>2013</year></pub-date><volume>31</volume><issue>3</issue><elocation-id>10.1097/MAO.0b013e3181c99524</elocation-id><abstract><sec id="S1"><title>Objective</title><p id="P1">1) To define the surgical anatomy and dimensions of the infracochlear approach to the petrous apex through use of high resolution computed tomography (HRCT) 2) use of digitized images of cadaveric temporal bones for computer simulation of infracochlear access using the OSC/OSU temporal bone simulator</p></sec><sec id="S2"><title>Background</title><p id="P2">The petrous apex is a surgically challenging area to access. Many routes have been described and used successfully in clinical practice. However, these routes have not been defined with the aim of application in computer-assisted surgery. The infracochlear approach, due to its access via a transcanal route, affords the opportunity for its potential application in minimally invasive computer-assisted surgery.</p></sec><sec id="S3"><title>Methods</title><p id="P3">High resolution CT (HRCT) scans were performed on 102 cadaveric skulls (total of 204 temporal bones). Standard measurements were taken using an open source Picture Archiving and Communication System (PACS) software of the maximum height, width, and depth of the infracochlear approach. In addition, the maximum diameter of a circular fenestration that could be created in the infracochlear space without breaching the basal turn of the cochlea, internal carotid artery, or the jugular bulb was used to simulate a drill path. In addition, five temporal bone specimens (3 left, 2 right) underwent HRCT with the digitized images being used to create simulated temporal bones for infracochlear surgical access; the transcanal infracochlear approach was then performed by the same surgeon on the cadaveric bone.</p></sec><sec id="S4"><title>Results</title><p id="P4">The mean height, width and depth of the infracochlear space in temporal bones with non-pneumatized petrous apices were 7.2 +/− 0.4mm, 9.4 +/− 0.8mm and 17.5 +/− 1.0mm respectively. Corresponding dimensions in pneumatized petrous apices were 7.6 +/− 0.4mm, 10.1+/− 1.1 and 18.6 +/−0.8mm. The mean diameter of the circular fenestra in the non-pneumatized petrous apices was 5.1 +/− 0.4mm compared to 5.7 +/− 0.6mm in pneumatized petrous pieces. This was statistically significant (Unpaired t-Test, p value = 0.04). The time to perform a simulated infracochlear approach to the petrous apex ranged from 3.1 – 12.6 minutes (mean: 6.1 minutes). The time to perform the same approach on the cadaveric bone ranged from 4.32 – 14.1 minutes (mean 9.3 minutes).</p></sec><sec id="S5"><title>Conclusions</title><p id="P5">Temporal bones with pneumatized petrous apices have an overall larger infracochlear space. The mean diameter of a circular infracochlear path that would avoid damage to vital structures was sufficiently large in both pneumatized and non-pneumatized petrous apices to have a potential application as a safe approach in computer-assisted surgery. Such an application is feasible with mating of a robotic system with CT or MRI guided imagery, which is the next phase of this study.</p></sec></abstract><funding-group><award-group><funding-source country="United States">National Center for Research Resources : NCRR</funding-source><award-id>UL1 RR025755 || RR</award-id></award-group><award-group><funding-source country="United States">National Institute on Deafness and Other Communication Disorders : NIDCD</funding-source><award-id>R01 DC006458 || DC</award-id></award-group></funding-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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