Article
Quantitative assessment of operative fields of minimal invasive approaches to the anterior fossa
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Authors
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Max Jägersberg
- Department of Neurosurgery, University of Geneva Medical Center, Switzerland
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Jeremy Brodard
- Department of Neurosurgery, University of Geneva Medical Center, Switzerland
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Karl Schaller
- Department of Neurosurgery, University of Geneva Medical Center, Switzerland
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Jean Fasel
- Department of Anatomy, University of Geneva Medical Center, Switzerland
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Walter Kucharczyk
- Toronto Western Research Institute, University of Toronto, Canada
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Jimmy Qiu
- Department of Medical Imaging, University of Toronto, Canada
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Ivan Radovanovic
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| Published: | May 13, 2014 |
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Outline
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Objective: Reducing exposure is a central interest for neurosurgical procedures. The aim of this study was to integrate a tool into the anatomy laboratory setting that allows for quantitative assessment of surgical corridors of different approaches for lesions of the anterior fossa and anterior arterial circulation, to compare less invasive approaches, namely the supraorbital, lateral supraorbital and mini-pterional approach to the gold standard, the pterional craniotomy. Moreover, we propose a maneuverability index that is based on this objective data.
Method: We performed supraorbital, lateral supraorbital, mini-pterional and standard pterional craniotomies in cadaver heads. Superficial and deep surface reference points and surgical target points were obtained by means of a conventional navigation tool. Offline, respective superficial and deep surfaces and corresponding operative field volumes were calculated and the surgical corridors visualized via a softwarel tool (GTxEyesII). We defined a score for evaluation of maneuverability (superficial surface, distance to target, bony obstacles, vascular lesion, range 5 [poor maneuverability] – 13 [excellent maneuverability]) for different surgical target points.
Results: 8 craniotomies of each type were performed in four cadaver heads. Superficial and deep surfaces [cm2] and volumes [cm3] were 6.2 (sd 1.3), 20.8 (sd 6.8), 42.9 (sd 15.4) for supraorbital; 6.4 (sd 1.0), 21.9 (sd 7.0), 44.6 (sd 13.4) for lateral supraorbital; 8.1 (sd 2.5), 21.3 (sd 3.6), 45.4 (sd 9.9) for minipterional and 17.6 (sd 2.9), 27.4 (sd 8.1), 77.4 (sd 16.9) for standard pterional craniotomies, respectively. The deep/superficial surface ratio was significantly higher for each keyhole approach when compared to standard pterional craniotomy (p<0.01). Maneuverability index scores showed highest values for standard pterional craniotomies, but nearly equally high scores could be achieved by the less invasive approaches for certain targets.
Conclusions: The three presented keyhole craniotomies can offer similar dimensions of deep exposure when compared to standard pterional craniotomy and can from this point of view be considered alternatives to the pterional approach. Maneuverability around surgical target points is more variable for keyhole craniotomies than for the pterional craniotomy. Our suggested maneuverability score offers objective criteria for choosing the appropriate approach to a given target. This score is to be validated and evaluated in the future.
