Abstract
Objective The usefulness of the bony surface registration method for navigation system image-guided
surgery in the lateral or prone position has been reported. This study was performed
to evaluate the efficacy of our new real-time navigation-guided drilling technique
with bony surface registration for skull base surgery in the middle and posterior
fossae.
Methods The study included 29 surgeries for skull base tumors that required drilling of the
petrous bone between January 2015 and December 2017 in Shinshu University Hospital.
A navigation system was used for drilling of the petrous bone as follows: (1) some
labyrinthine structures were marked by color in the source image and superimposed
on the navigation image on the workstation preoperatively; (2) bony surface registration
was performed with a three-dimensional (3D) skull reconstruction model in the operating
room; (3) the petrous bone was drilled under navigation guidance with real-time view-through
confirmation of 3D color-marked labyrinthine structures with observation under a microscopic
operative view.
Results Real-time identification of some structures in the petrous bone was performed, and
adequate and precise drilling of the petrous bone was achieved without the risk of
labyrinthine perforation or stress. Using this method, surgeons do not need to alternate
their gaze between the surgical field and the navigation screen.
Conclusions Due to the development of bony surface registration, this new technique is useful
for drilling petrous bone in the middle and posterior fossa skull base surgeries.
Keywords
navigation system - image-guided neurosurgery - bony surface registration - skull
base surgery - petrous bone
