ABSTRACT
Despite the widespread availability of surgical navigation devices, their use in lateral
skull base and temporal bone surgery has been limited. Problems with current systems
include difficulty of use and inadequate accuracy. We present a series of cases using
the LandmarX™ surgical navigation system as an adjunct for lateral skull base and
temporal bone procedures. This infrared emitting diodes (IRED)-driven system has a
post that carries the IREDs and bypasses the need to place the patient in a Mayfield
head holder. This configuration allows greater mobility of the surgical field. Registration
of the patient can include a combination of fiducial and anatomic landmarks that significantly
increase accuracy compared to fiducial calibration alone. We introduced the use of
the lateral process of the malleus as a landmark, thereby increasing accuracy within
the temporal bone to a range of 0.9 to 1.5 mm. We used the system on encephaloceles,
glomus tumors, meningiomas, and schwannomas, and revision surgery for chronic otitis
media. It decreased operating time, allowed more effective use of ``keyhole'' approaches,
and increased safety. As the availability and flexibility of these systems increase,
their use should become the standard of care in revision temporal bone and lateral
skull base procedures.
KEYWORD
Lateral skull base surgery - temporal bone surgery
