Abstract
IntroductionEndoscopic skull base approaches are broadly used in modern neurosurgery. The support of neuronavigation can help to effectively target the lesion avoiding complications. In children, endoscopic-assisted skull base surgery in combination with navigation systems becomes even more important because of the morphological variability and rare diseases affecting the sellar and parasellar regions. This paper aims to analyze our first experience on augmented reality navigation in endoscopic skull base surgery in a pediatric case series.Patients and methodsA retrospective review identified seventeen endoscopic-assisted endonasal or transoral procedures performed in an interdisciplinary setting in a period between October 2011 and May 2020. In all the cases, the surgical target was a lesion in the sellar or parasellar region. Clinical conditions, MRI appearance, intraoperative conditions, postoperative MRI, possible complications, and outcomes were analyzed.ResultsThe mean age of our patients was 14.5 ± 2.4 years. The diagnosis varied, but craniopharyngiomas (31.2%) were mostly represented. AR navigation was experienced to be very helpful for effectively targeting the lesion and defining the intraoperative extension of the pathology. In 65% of the oncologic cases, a radical removal was proven in postoperative MRI. The mean follow-up was 89 ± 79 months. There were no deaths in our series. No long-term complications were registered; two cerebrospinal fluid (CSF) fistulas and a secondary abscess required further surgery.ConclusionThe implementation of augmented reality to endoscopic-assisted neuronavigated procedures within the skull base was feasible and did provide relevant information directly in the endoscopic field of view and was experienced to be useful in the pediatric cases, where anatomical variability and rarity of the pathologies make surgery more challenging.
Highlights
Endoscopic skull base approaches are broadly used in modern neurosurgery
The objective of this paper is to retrospectively report our experience, with regard to morbidity in the field of endoscopic skull base surgery performed in combination with augmented reality (AR) in the pediatric population
Our study reports for the first time experience of using augmented reality (AR)-assisted navigated transnasal endoscopic neurosurgical procedures in a pediatric patient cohort
Summary
Endoscopic skull base approaches are broadly used in modern neurosurgery. The support of neuronavigation can help to effectively target the lesion avoiding complications. Endoscopic-assisted skull base surgery in combination with navigation systems becomes even more important because of the morphological variability and rare diseases affecting the sellar and parasellar regions. The implementation of neuronavigation into endoscopic procedures can help to better identify anatomical variations, the lesion’s boundaries within the surgical field, and spatial relations between lesion and normal tissue. New perspectives can be reached by implementing augmented reality (AR) technologies in neuronavigation systems This has already been used in microscopic-navigated neurosurgery, in which navigated information can directly be superimposed into the surgical field of view [2, 6, 26]. The technology enhances the definition of targets and their spatial relationships to neighboring structures Such advancements are relevant in the so called tunnel principle of endoscopic surgery, operator-related and system-borne biases still limit their routine use [3]
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