Automated Surgical Approach Planning for Complex Skull Base Targets: Development and Validation of a Cost Function and Semantic At-las.
Automated Surgical Approach Planning for Complex Skull Base Targets: Development and Validation of a Cost Function and Semantic At-las.
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DOI：
10.1177/1553350618782287
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发表时间：
2018-10
影响因子：
1.5
通讯作者：
Bly RA
中科院分区：
文献类型：
--
作者：
Aghdasi N;Whipple M;Humphreys IM;Moe KS;Hannaford B;Bly RA
成功的颅底病变的多学科治疗需要精确的术前计划。目前这些复杂手术的手术入路（路径）选择取决于外科医生的经验和背景培训。由于正常组织和病理（如肿瘤）的解剖变异，对一名患者使用的成功手术路径不一定是对另一名患者的最佳方法。问题是如何定义和获得优化的患者特异性手术入路路径？在这篇文章中，我们证明了外科医生的知识和决策，术前规划可以模拟的多目标成本函数在回顾性分析实际复杂的颅底病例。两种不同的方法-加权和方法和帕累托最优-被用来与一个定义的成本函数，以获得优化的手术路径术前计算机断层扫描（CT）扫描和手动指定的病理。对于第一种方法，在搜索之前，外科医生的偏好被输入作为每个目标的一组权重。在第二种方法中，外科医生的偏好被用来从计算的帕累托最优集合中选择手术路径。使用术前CT和磁共振成像，通过这些方法得出的患者特异性手术路径与对患者进行的实际方法相似（85%一致性）。在1例实际手术入路不同的病例中，需要进行翻修手术，并使用计算得出的入路路径进行。
Successful multidisciplinary treatment of skull base pathology requires precise preoperative planning. Current surgical approach (pathway) selection for these complex procedures depends on an individual surgeon’s experiences and background training. Because of anatomical variation in both normal tissue and pathology (eg, tumor), a successful surgical pathway used on one patient is not necessarily the best approach on another patient. The question is how to define and obtain optimized patient-specific surgical approach pathways? In this article, we demonstrate that the surgeon’s knowledge and decision making in preoperative planning can be modeled by a multiobjective cost function in a retrospective analysis of actual complex skull base cases. Two different approaches— weighted-sum approach and Pareto optimality—were used with a defined cost function to derive optimized surgical pathways based on preoperative computed tomography (CT) scans and manually designated pathology. With the first method, surgeon’s preferences were input as a set of weights for each objective before the search. In the second approach, the surgeon’s preferences were used to select a surgical pathway from the computed Pareto optimal set. Using preoperative CT and magnetic resonance imaging, the patient-specific surgical pathways derived by these methods were similar (85% agreement) to the actual approaches performed on patients. In one case where the actual surgical approach was different, revision surgery was required and was performed utilizing the computationally derived approach pathway.
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影响因子：
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作者：
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通讯作者：
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Kikinis, Ron
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作者：
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通讯作者：
Gil, Ziv
影响因子：
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作者：
KIRKPATRICK, S;GELATT, CD;VECCHI, MP
通讯作者：
VECCHI, MP