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多种多样，由于靠近颈动脉、大脑、眼眶、视神经和视交叉，导致严重的发病率。对于大多数病变，手术活检，切除，或 减积是治疗的基本方面。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，与开放性开颅手术方法相比，这大大降低了获得手术入路的发病率。然而，经鼻入路并不足以治疗所有病变，如果累及外侧结构，则需要开颅手术。梨状孔处的几何约束将器械之间的角度限制为15度，当操纵颅底上9 cm深度处的目标时。 为了提高操纵目标的能力，一种选择是通过使用额外的手术入口来加宽器械之间的角度。许多入口被描述为进入颅底，但很少有人将不同的入口结合起来，以优化某个目标位置的入路;入口包括经鼻、经口、经眶、眶上、经上颌、经颅和经脑室。 已经组建了一个多学科的工程师和外科医生团队，包括耳鼻喉科、神经外科、泌尿外科和机器人外科以及眼眶外科。在团队中有教授，主治外科医生，工程研究生和住院外科医生在培训。我们的目标是开发一种改进的三维计算机模型，以确定和测试最佳的方法，内窥镜进入和切除颅底病变。利用个性化的影像学信息，它将提供术前手术预演，以改善手术效果，最大限度地减少不良反应。最初，垂体周围的临床相关颅底目标将被定义为肿瘤侵袭经常发生的位置。将进行仿真内窥镜检查，通过各种内窥镜入路（包括现有标准内窥镜入路和新型多入口入路）进入指定的颅底目标。多入口入路在器械之间提供了更宽的角度，这将适应当前的手术机器人平台。该模型将在尸体标本中进行验证，并将在两个机器人手术系统上评估机器人可行性。我们将使用该模型来检验以下假设：多入路方法显著拓宽了进入目标的角度，并最大限度地降低了器械碰撞设定解剖方案的概率。 预计计算机模型将展示最短，最直接，最少创伤的颅底靶点通路。将生成关于方法组合的规范性数据，最终，这些结果将作为未来机器人集成和计算机模拟到颅底手术的平台。

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.