Use Of Surgical Navigation Research Articles

Use of navigation technologies in the installation of external ventricular drainage in patients with severe combined traumatic brain injury

The study investigated the possibilities and effectiveness of surgical navigation in the installation of external ventricular drainage in patients with severe combined traumatic brain injury. In total, 41 patients were examined, and in those with urgent indications during the first period of traumatic illness, external ventricular drainage was installed (up to 2 days). All patients were divided into the main group (n = 14) and control group (n = 27). In the main group, external ventricular drainage was installed using surgical navigation. The control group underwent surgery without surgical navigation. According to the treatment results of the main group, the use of surgical navigation during the introduction of ventricular drainage significantly increased the accuracy of its installation and reduced the number of complications and rechecks. The accuracy of ventricular drainage installation was improved by 35%. Thus, out of 13 drainage installations, 12 (92.3%) had an optimal position, and 1 had a satisfactory position because its tip had a deviation of 2 mm; however, this drainage did not require re-examination, performing its function. Moreover, in the control group using the classical free hand technique, out of 21 cases with drainage installed, only 12 (57.1%) had an optimal position, 9 (42.9%) drains were rechecked because of deviation from the specified trajectory over 3 mm, and 4 (19%) required repeated rechecking (p = 0.039). The main causes of errors and complications of the surgical treatment of patients with craniocerebral injuries are related to the difficulties in installing ventricular drainage, namely, inaccurate positioning of the drainage tip, placement of the drainage in the brain substance at a distance from the planned point (28.6%), the drainage is going beyond the ventricular system of the brain (14.3%), re-drainage during the operation (44.4%), which often (42.9%) leads to incorrect introduction of the drainage into the ventricular system of the brain. Thus, the application of the navigation technology technique when installing drains into the ventricular system of the brain is very effective in the treatment of patients with severe combined traumatic brain injury. This innovative technique for ventricular drainage in severe combined traumatic brain injury will reduce the frequency of errors and complications associated with repeated drains, which is fundamentally important in unstable patients with multiple traumas. The navigation system allows for accurate installation of the drainage to the planned location from the first attempt.

Surgical navigation in maxillofacial surgery: A French national survey

Purposeto gain a national understanding of the utilization of surgical navigation among maxillofacial surgeons in France through a web-based questionnaire. MethodsA 14-point multiple-choice questionnaire was created and distributed to the participants, divided into two sections. The first section gathered general information about the respondents, and the second section provided an overview of the use of surgical navigation. ResultA total of 75 participants completed the survey. The results showed that a majority of university hospital departments (65%) utilize an intra-operative 3D imaging system, while very few private clinics and general hospitals use this technology. ConclusionThe survey suggests that surgical navigation is primarily used in university centers in French maxillofacial surgery, with limited utilization and non-standardized indications for use.

Training arthrocentesis and arthroscopy: Using surgical navigation to bend the learning curve

ObjectiveTemporomandibular joint arthroscopy and arthrocentesis are generally considered safe and minimally invasive surgical procedures. For an inexperienced surgeon, the complex anatomy of the surgical field and the limited visibility represent a significant challenge, and many surgical training programmes are considered limited in providing the adequate training.Technological advancements, involving surgical navigation, facilitate planning, execution, and evaluation of various complex surgical treatments and represent a very promising addition to the surgical training toolkit. TechniqueThis article presents the use of surgical navigation as an additional training tool in teaching level I and II arthroscopy to resident surgeons. Surgical navigation is used to aid the trainee by controlling the starting point and angulation, inspect anatomical landmarks and discus consequences of errors in angulation. While the trainee performs the puncture, the instructor oversees both the surgical field and the anatomy on the surgical navigation screen. ConclusionIt is demonstrated that real-time guidance provided by a surgical navigation system can be used as a training tool for surgeons with limited previous experience in arthroscopic procedures. This application could help improve the safety for the patient and provide a deeper educational level in training surgeons. Still, clinical and tactile feedback perioperatively should remain a primary guideline. Factors such as financial investments, challenges in implementation and a steep learning curve regarding the navigation system must be considered.

Imageless Computer Navigation Reduces 5-Year All-Cause Revision Rates After Primary Total Knee Arthroplasty.

The use of surgical navigation has been shown to reduce revision rates after total knee arthroplasty (TKA) in patients <65 years of age. It is unknown if this benefit extends to older patients. We hypothesized that the use of surgical navigation would reduce rates of all-cause revision in patients of all ages. In this cohort study, we queried the Truven MarketScan all-payer database to identify patients who underwent TKA from 2007 to 2015. Current Procedural Terminology codes were used to create 2 groups based on whether intraoperative navigation was used. Demographics, comorbidities, complications, and revision rates were determined. International Classification of Diseases codes were used to determine reasons for revision. The conventional TKA cohort included 312,173 patients. The navigation cohort included 20,881 patients. There were not any clinically significant differences in demographics between the cohorts. All-cause revision rates were lower in the navigation cohort at 1 year (0.4% vs 0.5%, P= .04), 2 years (0.7% vs 0.9%, P= .003), and 5 years (0.9% vs 1.3%, P < .001) of follow-up. Revisions for mechanical loosening were more common in the conventional cohort (30.8% vs 21.9%, P= .009). Rates of revision for other causes, including infection, did not differ between groups, with the numbers available. The use of surgical navigation yielded a 30.7% reduction in the all-cause revision rate at 5-year follow-up compared to conventional TKA. This benefit increased as follow-up duration increased. Increased usage of this inexpensive technology, from the current 6.3% in this US cohort, may reduce healthcare costs. III.

Contour Map Point Distribution and Surgeon Experience Level Affect Accuracy of Surgical Navigation in a Pilot Study.

Reliable use of surgical navigation depends upon the registration process. The gold standard is paired-point registration with bone-anchored fiducials, but contour-map registration is more practical. Surgeons may employ variable contour maps and less experienced team members often perform this critical step. The impact of these practices on target registration error (TRE) is not well-studied. A dry lab set-up consisting of a navigation system (Fusion ENT, Medtronic, Jacksonville, FL) and a sinus phantom with 2 mm radiopaque spheres in the sphenoid and ethmoid regions was developed. A CT (0.625 mm slice thickness) was obtained. Registration was performed with a contour-based protocol. Accuracy was determined using the software's distance measurement tool. Registration was performed with narrow-field (NF; forehead points medial to the mid-pupillary line) and wide field (WF; entire forehead) contour maps. An experienced rhinologist and a resident surgeon performed each registration in triplicate and TRE at the sphenoid and ethmoid markers was measured in triplicate. WF mapping had a lower TRE than NF (1.09 mm [95% Confidence Interval (CI) 0.96-1.22] vs 1.68 mm [95% CI 1.50-1.86]). The experienced surgeon had a lower TRE compared to the resident (1.21 mm [95% CI 1.08-1.34] vs 1.54 mm [95% CI 1.35-1.74]). In this navigation model, wide field mapping offers better accuracy than narrow-field mapping, and an experienced surgeon seemed to achieve better accuracy than a resident surgeon. These observations have potential implications for the use of this technology in the operating room.

Correction of Severe Frontal Bossing with Coronal Brow Lift and Osteoplastic Frontal Sinus Setback Aided by Virtual Surgical Planning: A Case Report

Objective: An 18 year old male with a hypoplastic midface, low anterior hairline, heavy brows and marked frontal bossing presented for evaluation. Laboratory evaluation for acromegaly was negative. He did have impairment of his bilateral visual fields as confirmed by visual field testing by ophthalmology. His nasal radix was also of particular concern to him as it formed a significantly depressed crease between his nasal bridge and his brow. He requested surgical correction of these deformities from both a functional and aesthetic standpoint. Methods: We performed thin-cut CT maxillofacial scanning with 3D reformats and submitted this for virtual surgical planning (VSP). We were able to create a template with which to remove the anterior table of the frontal sinus safely, confidently, and without the aid of a craniotomy. The operation was performed through a preexisting bicoronal incision. The anterior table of the frontal sinus was removed in one piece. His forehead and superior orbits were contoured with a burr. After contouring, the anterior table was fixated in a more recessed position. Nasal radix augmentation was also performed using bone grafting. A coronal brow lift was then performed. Results: The patient’s post-operative course was uneventful. He noted marked improvement in his superior visual fields. He had complete resolution of his nasal radix deformity and his frontal bossing. This was confirmed by thin-cut CT maxillofacial scanning postoperatively. His frontal branches were functionally intact and his hairline was raised to a more appropriate position. Conclusions: Virtual surgical planning allowed us to perform an osteoplastic forehead reduction safely and without older methods such as Caldwell x-rays with coin reference, transillumination, or the bayonet forcep technique. It also allowed us to avoid the use of surgical navigation which can be time consuming and cumbersome. This VSP-based access to the frontal sinus has applications in many aspects of reconstructive cranial surgery as well as aesthetic forehead reductions for patients that do not require a craniotomy.

Surgical Navigation for Oral and Maxillofacial Surgery.

This article reviews the basic setup and function of surgical navigation and displays a variety of applications in oral and maxillofacial surgery. The use of surgical navigation for dental implant placement is discussed elsewhere in this issue.

Quantitative assessment of symmetry recovery in navigation-assisted surgical reduction of zygomaticomaxillary complex fractures

PurposeTo evaluate the effects of surgical navigation in zygomaticomaxillary complex (ZMC) fracture reduction. ZMC symmetry was assessed quantitatively. Materials and methodsThe sample comprised 25 patients who underwent surgical reduction of comminuted ZMC fractures. They were divided into two groups according to the use of surgical navigation. Reduction outcomes were evaluated using three-dimensional computed tomography models. Five pairs of landmarks were identified on all craniofacial models, and asymmetry scores were calculated based on their coordinates. In quantitative analyses, symmetry and orbital volume were compared between groups. ResultsAll patients recovered uneventfully. Greater symmetry was observed in the navigation group than in the control group for three of the five pairs of landmarks (p < 0.05). Although postoperative volumes of the injured orbits were similar between the two groups (p > 0.05), reduced orbital volumes were larger in the navigation group, indicating better restoration of the fractured orbits (p < 0.05). ConclusionsThe use of surgical navigation can increase postoperative symmetry of the bilateral ZMC. The quantitative evaluation of clinical outcomes is precise and highly reliable.

Перспективы использования хирургической навигации при коррекции врожденных пороков развития в неонатологии

Перспективы использования хирургической навигации при коррекции врожденных пороков развития в неонатологии

Intraoperative Image Guidance Improves Outcomes in Complex Orbital Reconstruction by Novice Surgeons

This study aims to describe the utility of surgical navigation in improving operative outcomes in complex orbital reconstruction by novice compared with experienced surgical trainees. A randomized, controlled cadaveric study was conducted at the University of Pittsburgh School of Medicine with otolaryngology and ophthalmology residents and fellows. Participants were divided into novice (postgraduate year 2-4 residents) and experienced (postgraduate year 5 residents and fellows) groups. Ten cadaveric specimens with pre-dissection computed tomography images underwent endoscopic resection of the orbital floor and lamina papyracea bilaterally. Participants performed reconstruction with or without the use of surgical navigation, randomized by laterality and order of the use of navigation. Post-dissection imaging was obtained after reconstruction and compared with pre-dissection imaging. The primary outcome was orbital volume; secondary outcomes included the participant's operative time and National Aeronautics and Space Administration Task Load Index score, a subjective workload assessment measure. Matched-pair t tests and 2-way analysis of variance were used for statistical analysis. Novice participants (n= 6) had improved outcomes with respect to orbital volume when using surgical navigation compared with experienced participants (n= 4). There were no differences in operative times or National Aeronautics and Space Administration Task Load Index scores when using surgical navigation. In a cadaveric setting, use of surgical navigation by novice surgeons improves post-dissection orbital volume in complex orbital reconstruction. Surgical navigation should be considered as an adjunct to surgical training and simulation curricula.

Surgical management of maxillofacial fibrous dysplasia under navigational guidance

Fibrous dysplasia is a benign and slowly progressive disorder of bone in which normal cancellous bone is replaced by immature woven bone and fibrous tissue. Precise excision of the lesion is crucial to restore function and aesthetics. We present our experience using surgical navigation technology for the recontouring of the faces of 8 patients with maxillofacial fibrous dysplasia who were treated from 2012–2013, all of whom were thought suitable for surgical recontouring. Preoperative computed tomography (CT) scans were used to make a virtual plan based on the patient's mirrored anatomy. During the operation we fixed a rigid digital reference frame to the patient's forehead or mandible, depending on the site of the lesion. The patient and the virtual image were matched through an individual recording technique. A pointing device was in constant use to find out whether the extent of resection was consistent with the preoperative design, and we assessed the surgical outcome by fusion of the preoperative planning and postoperative CT reconstruction images. The acquisition of the data sets was uncomplicated, and the use of surgical navigation improved the safety and the accuracy of the recontouring. There were no complications during 1–2 years follow up. Navigational guidance based on a virtual plan is safe and accurate, and is of value in the management of maxillofacial fibrous dysplasia.

Does Computer Navigation Improve the Results of MIS Technique in Total Knee Arthroplasty?

The Minimal Invasive Surgery (MIS) technique used for knee arthroplasty implantation implies a less aggressive surgery and reduces the aesthetic impact. Its most notable disadvantage is the poor visualization of bone structures, which may lead to alterations in the correct placement of the prosthetic components. Navigation-assisted surgery may help avoid such mistakes, and thus navigation coupled with the MIS technique may be an alternative for the future. This is a prospective randomized study of 50 patients who received a total knee arthroplasty. In 25 cases the MIS technique was used, whereas in the other 25 navigation was also employed. Mean age of the patients was 71.63 years, and the mean body mass index was 31.19. Results were assessed based on the definitive radiographic position of the femoral, tibial, and limb axis prosthetic components, as well as according to the Visual Analogue Scale (VAS), the Knee Society Score (KSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Short Form version 12 (SF-12) questionnaires, and the “up-and-go” test. Differences were found between both groups for duration of the procedure (p = 0.0005). No differences were found in the need for analgesics, amount of drained blood, or mean stay time. There were differences regarding the best radiographic position of the tibial component in the navigation group, but not in the final mechanical axis of the limb, even though out-of-range cases were more abundant in the standard-MIS group. At one year after surgery, clinical, functional and quality of life outcomes were similar in both groups. The combined use of surgical navigation and the MIS technique does not yield advantages in terms of limb alignment nor clinical results at one year after surgery.

Surgical navigation for meningioma surgery

The use of surgical navigation systems (SNSs) is well established in intracranial surgery for gliomas and metastases yet some doubt its benefit in surgery for intracranial meningiomas. In this chapter we review the authors' experiences and literature on how use of surgical navigation may be useful in craniotomy for intracranial mengingiomas. With the exception of small convexity meningiomas, finding the tumor is not a common problem. The most important issues where the capabilities of SNS can be used to the surgeon's advantage are optimizing the bone and dural opening, avoiding arterial and venous structures, defining the frontal air sinuses and determining one's location within a large tumor devoid of landmarks. Contemporary SNS can provide instantaneous localization and orientation information, as well as utilize multimodality imaging that is required to address these problems and is an effective means of optimizing surgery for many intracranial meningiomas.

Withdrawn: Poster Board Number: 46: Use of Surgical Navigation in Soft Tissue Recontouring—A Technical Note

Withdrawn: Poster Board Number: 46: Use of Surgical Navigation in Soft Tissue Recontouring—A Technical Note

In-Vitro Investigation of a Noninvasive Referencing Technology for Computer-assisted Total Hip Arthroplasty

The use of surgical navigation to aid in total joint replacement requires the bony fixation of reference marker arrays. In this context, a number of potential complications have been reported, including pin-site infection, soft tissue morbidity, and stress fracture. This study was performed to determine whether a femoral pinless, imageless navigation method for total hip arthroplasty (THA) is an accurate alternative method of measuring leg-length and offset change intraoperatively. Computer-assisted THA was simulated on a Sawbones bench test model including a femoral soft tissue model. Leg-length and offset changes were calculated by an imageless navigation system using the pinless measurement algorithm, in which the calculation of leg-length and offset changes is based on a specific realignment of the leg and then compared to corresponding measurements on a millimeter scale at the level of the femoral condyles. Mean difference in leg-length measurement (navigation versus millimeter paper) was 0.9 mm (95% confidence interval [CI]: 0.03-1.7 mm, P=.043), and the corresponding mean difference in offset was 1 mm (95% CI: 0.06-1.9 mm, P=.038). A noninvasive, pinless femoral system is a reliable tool for controlling leg length and offset during THA in an in-vitro setup. This system could lead to a reduction of potential risks associated with navigation techniques.

Use of surgical navigation during endoscopic skull base surgery

The use of surgical navigation has grown tremendously in endonasal endoscopic surgery. The technology has been used as an adjunct during endoscopic surgery of the skull base. Although not requisite, the benefits of navigation during endoscopic skull base surgery may lie in its ability to enhance a surgeon's approach to complex anatomic structures. The use of navigation during endoscopic skull base surgery does not completely parallel its use during surgery for inflammatory sinus disease, and those differences can be critical. For example, in endoscopic skull base surgery, soft tissue structures play a more prominent role during the dissection than in a typical surgery for inflammatory disease. Preoperatively, there are some particular issues that a navigated case will require above and beyond a non-navigated surgery, including obtaining appropriate radiographic studies, performing the appropriate preoperative software-based planning, and discussions with the patient. Intraoperatively, the set up of the navigation system in the operating room should augment the surgeon's operative field and maximize the utility of the navigation system. Specific indications where navigation may be useful include the endoscopic approach to sellar and parasellar lesions, benign anterior skull base tumors, encephaloceles, CSF leaks, and the like. The endoscopic surgeon who is performing skull base procedures should consider computer assisted navigation to be a helpful tool in his/her armamentareum.

Computer Assistance Increases Precision of Component Placement in Total Knee Arthroplasty with Articular Deformity

The accuracy of computer navigation applied to total knee arthroplasty (TKA) in knees with severe deformity has not been studied. The purpose of this study was to compare the radiographic alignment achieved in total knee replacements performed with and without navigation and to search for differences in the final alignment of two groups of patients (with and without previous joint deformities) using the same system of surgical navigation. The first series comprised 40 arthroplasties with minimal preoperative deformity. In 20 of them, surgical navigation was used, whereas the other 20 were performed with conventional jig-based technique. We compared the femoral angle, tibial angle, and femorotibial angle (FTA) by performing a post-TKA CT of the entire limb. In the second series, 40 additional TKAs were studied; in this case, however, they presented preoperative deformities greater than 10 masculine in the frontal plane. The positioning of the femoral and tibial component was more accurate in the group treated with surgical navigation and FTA improvement was statistically significant. When comparing the results of both series, FTA precision was always higher when using computer-assisted surgery. As for optimal FTA, data showed the use of surgical navigation improved the results both in the group with preoperative deformity greater than 10 degrees in the frontal plane and in the group with minimal preoperative knee deformity. Surgical navigation obtains better radiographic results in the positioning of the femoral and tibial components and in the final axis of the limb in arthroplasties performed on both deformed and more normally aligned knees. Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Percutaneous laser discectomy guided with stereotactic computer‐assisted surgical navigation

Percutaneous laser discectomy at various wavelengths has been used for minimally invasive surgery of herniated intervertebral discs. Using a high-intensity diode laser at 980-nm wavelength, we aimed to improve the safe insertion of the laser trocar with the aid of a stereotactic computer-assisted surgical navigation system. The experiments were performed on ex vivo porcine spines with intact soft tissue. Before laser irradiation, each specimen was imaged by computed tomography (CT) with fiduciary markers. The Digital Imaging and Communications in Medicine (DICOM standard) data sets were retrieved into the GE Healthcare Surgery InstaTRAK3500 Plus computer-assisted surgical navigation platform via the hospital Ethernet using a picture archiving and communication system. A special trocar with quartz waveguide connected to the navigation system was inserted into a total of 12 lumbar discs of two fresh intact porcine specimens. Various laser energies (200-700 J) with different exposure times were delivered. Pre- and post-irradiation magnetic resonance (MR) imaging and postoperative macroscopic and histologic studies were carried out. A navigation system accuracy of better than 2 mm was achieved. Tracking of the instrument from pre-acquired formatted CT reconstructed images reduced overall radiation exposure by limiting the need for continuous intraoperative C-arm fluoroscopy. The use of surgical navigation by CT images enhanced the precision insertion of the laser trocar. Irradiation with the 980-nm wavelength diode laser resulted in tissue evaporation changes of the intervertebral disc material as demonstrated by comparing pre- and post-irradiation changes of MR images and macro- and microscopic changes of the dissected disc material. This preclinical study demonstrates the clinical utility of a 980-nm diode laser delivered through a fiber-optic waveguide trocar in which precise insertion was enabled by the use of surgical navigation. This in turn decreases the exposure to ionizing radiation during the procedure.

Surgical Navigation Technology for Treatment of Pneumosinus Dilatans

The objective of this study is to present the use of surgical navigation in the selective removal of the anterior table of the frontal sinus in a patient with pneumosinus dilatans. A 16-year-old boy presented with progressive deformity of the forehead and left postauricular sulcus due to pneumosinus dilatans. Reconstruction of the anterior table of the frontal bone was assisted by a surgical navigation system that used data from a preoperative computed tomography scan of the head and neck to map out the boundaries of the frontal sinus. The device enabled selective resection of the anterior table without violation of the cranial cavity.

Impact of image guidance on complications during osteoplastic frontal sinus surgery

Objectives To evaluate the impact of image-guidance technology on intraoperative complications during frontal sinus obliteration surgery. Study design and setting Retrospective case control. Twenty-four patients underwent frontal sinus obliteration with image-guidance technology (n = 15) or conventional instrumentation (n = 9) between 1992 and 2003. The image-guidance system was used to delineate the frontal sinus perimeter and direct cuts through the frontal bone. Results Intraoperative complications occurred in none of the patients in the image-guidance group and in 3 patients in the control group ( P = 0.042). Adverse events included dural tear with CSF leak in 2 patients and exposure of orbital fat in 1 patient. The incidence of postoperative complications was similar between groups ( P = 0.326). No patients required revision surgery. Mean follow-up was 5.2 years. Conclusions The use of surgical navigation during frontal sinus obliteration appears to improve intraoperative safety. Significance This is the first report to document a reduction in the rate of intraoperative complications when image guidance is utilized for frontal sinus surgery.