ABSTRACT
Objective: Skull base anatomy is complex and subject to individual variation. Understanding
the complexity of surgical anatomy is faster and easier with virtual models created
from primary imaging data of the patient. This study was designed to investigate the
usefulness of virtual reality in image guidance for skull base procedures. Design:
Primary volumetric image data from 110 patients was acquired using magnetic resonance,
computed tomography (CT), and CT angiography. Pathologies included lesions in the
anterior, middle, and posterior skull base. The data were transferred to an infrared-based
image-guidance system for creation of a virtual operating field (VOF) with translucent
surface modulation and optional “fly-through” video mode. During surgery, the target
registration error for anatomical landmarks was assessed and the VOF was compared
with the patient's anatomy in the operative field. Results: Complex structures like
the course of the sigmoid sinus, the carotid artery, and the outline of the paranasal
sinuses were well visualized in the VOF and were recognized by the surgeon instantly.
Perception was greatly facilitated as compared with routine mental reconstruction
of triaxial images. Accurate assessment of the depth of field and very small objects
was not possible in VOF images. Conclusion: Supported by sound anatomical knowledge,
creation of a virtual operating field for a surgical approach in an individual patient
offers a déjà vu experience that can enhance the capabilities of a surgical team in
skull base approaches. In addition, application of this technique in image-guided
procedures assists in targeting or avoiding hidden anatomical structures.
KEYWORDS
Three-dimensional image guidance - virtual reality - skull base approaches
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Steffen K RosahlM.D.
Department of Neurosurgery, University of Freiburg
Breisacher Str. 64, D-79106, Freiburg, Germany