Warning navigation system using real-time safe region monitoring for otologic surgery
Warning navigation system using real-time safe region monitoring for otologic surgery
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DOI：
10.1007/s11548-012-0797-z
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发表时间：
2013-05-01
影响因子：
3
通讯作者：
Hashizume, Makoto
中科院分区：
文献类型：
--
作者：
Cho, Byunghyun;Oka, Masamichi;Hashizume, Makoto
我们开发了一种手术导航系统，通过听觉和视觉反馈来警告外科医生，在钻孔过程中通过实时监测安全区域来保护面神经。方法开发预警导航模块，并将其集成到免费开源软件平台中。为了获得高配准精度，我们使用高精度激光烧结患者骨表面模板来配准计算机断层扫描（CT）图像。我们计算了钻孔过程中钻头与面神经表面的最近距离。当钻头进入安全区域时，导航系统提供不同安全区域的听觉和视觉信号。为了评估该系统的有效性，我们进行了假体实验，以在钻孔骨模型时保持给定的面神经安全边缘，无论是否有导航系统。在术后CT图像上测量安全边界的误差。在实际手术中，我们评估了该系统与传统面神经监测的可行性。结果目标配准误差的导航精度为亚毫米级。在幻像研究中，有导航（mm）的任务比没有导航（mm,）的任务更成功，误差更小。三例实际手术证实了该系统的临床可行性。结论该系统可以帮助外科医生保护面神经，并有可能提高手术患者的安全性。
Purpose We developed a surgical navigation system that warns the surgeon with auditory and visual feedback to protect the facial nerve with real-time monitoring of the safe region during drilling.Methods Warning navigation modules were developed and integrated into a free open source software platform. To obtain high registration accuracy, we used a high-precision laser-sintered template of the patient's bone surface to register the computed tomography (CT) images. We calculated the closest distance between the drill tip and the surface of the facial nerve during drilling. When the drill tip entered the safe regions, the navigation system provided an auditory and visual signal which differed in each safe region. To evaluate the effectiveness of the system, we performed phantom experiments for maintaining a given safe margin from the facial nerve when drilling bone models, with and without the navigation system. The error of the safe margin was measured on postoperative CT images. In real surgery, we evaluated the feasibility of the system in comparison with conventional facial nerve monitoring.Results The navigation accuracy was submillimeter for the target registration error. In the phantom study, the task with navigation ( mm) was more successful with smaller error, than the task without navigation ( mm, ). The clinical feasibility of the system was confirmed in three real surgeries.Conclusions This system could assist surgeons in preserving the facial nerve and potentially contribute to enhanced patient safety in the surgery.