Computer Modeled Multiportal Approaches to the Skull Base

描述(由申请人提供)：前颅底和中颅底病变的病因各不相同，由于靠近颈动脉、脑、眼眶、视神经和交叉而导致显著的发病率。对于大多数病变，手术活检、切除或 去除树枝是治疗的一个基本方面。过去几十年的技术进步现在允许在许多情况下经鼻内窥镜手术入路，与开放开颅手术相比，这极大地降低了获得手术入路的发病率。然而，经鼻入路并不足以满足所有病变的需要，如果累及侧方结构，则需要开颅手术。当在颅底9厘米深的地方操纵目标时，梨形光圈的几何约束将仪器之间的角度限制在15度。为了提高操纵靶点的能力，一种选择是通过使用额外的手术入口来扩大器械之间的角度。许多入口被描述为进入颅底，但很少有人研究如何结合不同的入口以优化特定靶点位置的入路；入口包括经鼻、经口、经眶、眶上、经上颌骨、经宫颈和经脑室。一支由来自耳鼻喉科、神经外科、泌尿科和机器人外科以及眼眶外科等子专业的工程师和外科医生组成的多学科团队已经组建完毕。团队中有教授、主治外科医生、工程学研究生和正在接受培训的住院外科医生。我们的目标是开发一种改进的3D计算机模型，以识别和测试内窥镜下进入和切除颅底病变的最佳方法。利用个性化的成像信息，它将提供术前手术预演，以改善手术结果，并将不良反应降至最低。最初，临床上相关的脑垂体周围的颅底靶点将被定义为经常发生肿瘤侵袭的位置。将通过各种内窥镜方法，包括现有的标准内窥镜途径和新的多入口途径，进行虚拟内窥镜检查，以访问指定的颅底靶点。多入口方法在器械之间提供了更宽的角度，这将适应当前的外科机器人平台。该模型将在身体标本中得到验证，机器人的可行性将在两个机器人手术系统上进行评估。我们将使用这个模型来检验这样的假设，即多入口方法显着拓宽了进入目标的角度，并将器械碰撞的可能性降至最低。预计计算机模型将展示到颅底目标的最短、最直接和最小创伤的路径。将产生有关入路组合的标准数据，最终，这些结果将成为未来颅底手术中机器人集成和计算机模拟的平台。

DESCRIPTION (provided by applicant): Lesions of the anterior and middle skull base are diverse in their etiology and cause significant morbidity due to close proximity to the carotid arteries, brain, orbits, optic nerves and chiasm. For most lesions, a surgical biopsy, excision, or debulking is an essential aspect of treatment. Technological advances over the past few decades now permit transnasal endoscopic surgical access in many instances, which has dramatically reduced the morbidity of gaining surgical access compared to an open craniotomy approach. However, transnasal access is not sufficient for all lesions, which require an open craniotomy if lateral structures are involved. The geometric constraints at the pyriform aperture limit the angle between instruments to 15 degrees when manipulating a target at a depth of 9 cm on the skull base. To improve the ability to manipulate a target, one option is to widen the angle between instruments by using additional surgical portals. Many portals are described to access the skull base, but little work has been done on combining different portals in order to optimize an approach for a certain target location; portals include transnasal, transoral, transorbital, supraorbital, transmaxillary, transcervical, and transventricular. A multidisciplinay team of engineers and surgeons from subspecialties including otolaryngology, neurosurgery, urology and robotic surgery, and orbital surgery has been assembled. Within the team are professors, attending surgeons, engineering graduate students, and resident surgeons in training. We aim to develop an improved 3D computer model to identify and test optimal approaches for endoscopic access and excision of skull base lesions. Using individualized imaging information, it will offer preoperative surgical rehearsal to improve surgical outcomes and minimize adverse effects. Initially, clinically relevant skull base targets around the pituitar will be defined as locations where tumor invasion often occurs. Virtual endoscopy will be performed to access the specified skull base targets through a variety of endoscopic approaches, including existing standard endoscopic approaches and novel multiportal approaches. The multiportal approach provides wider angles between instruments, which will accommodate current surgical robotic platforms. The model will be validated in cadaver specimens and robotic feasibility will be assessed on two robotic surgery systems. We will use this model to test the hypothesis that multiportal approaches significantly broaden the angle of access to the target and minimize the probability of instrument collisions on set protocols of dissection. It is anticipated that the computer model will demonstrate the shortest, most direct, and least traumatic pathways to skull base targets. Normative data on the approach combinations will be generated and ultimately, these results will serve as a platform for future robotic integration and computer simulation into skull base surgery.