Skull Base 2011; 21(4): 261-270
DOI: 10.1055/s-0031-1280681
ORIGINAL ARTICLE

© Thieme Medical Publishers

Comparison of Intraoperative Portable CT Scanners in Skull Base and Endoscopic Sinus Surgery: Single Center Case Series

David B. Conley1 , Bruce Tan1 , Bernard R. Bendok2 , 3 , H. Hunt Batjer2 , Rakesh Chandra1 , Douglas Sidle1 , Rudy J. Rahme2 , Joseph G. Adel2 , Andrew J. Fishman1 , 2 , 4
  • 1Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago
  • 2Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago
  • 3Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago
  • 4Hugh Knowles Foundation, Center for Communicative Sciences and Disorders, Northwestern University, Evanston, Illinois
Further Information

Publication History

Publication Date:
09 June 2011 (online)

ABSTRACT

Precise and safe management of complex skull base lesions can be enhanced by intraoperative computed tomography (CT) scanning. Surgery in these areas requires real-time feedback of anatomic landmarks. Several portable CT scanners are currently available. We present a comparison of our clinical experience with three portable scanners in skull base and craniofacial surgery. We present clinical case series and the participants were from the Northwestern Memorial Hospital. Three scanners are studied: one conventional multidetector CT (MDCT), two digital flat panel cone-beam CT (CBCT) devices. Technical considerations, ease of use, image characteristics, and integration with image guidance are presented for each device. All three scanners provide good quality images. Intraoperative scanning can be used to update the image guidance system in real time. The conventional MDCT is unique in its ability to resolve soft tissue. The flat panel CBCT scanners generally emit lower levels of radiation and have less metal artifact effect. In this series, intraoperative CT scanning was technically feasible and deemed useful in surgical decision-making in 75% of patients. Intraoperative portable CT scanning has significant utility in complex skull base surgery. This technology informs the surgeon of the precise extent of dissection and updates intraoperative stereotactic navigation.

REFERENCES

  • 1 Miracle A C, Mukherji S K. Conebeam CT of the head and neck, part 1: physical principles.  AJNR Am J Neuroradiol. 2009;  30 (6) 1088-1095
  • 2 Rumboldt Z, Huda W, All J W. Review of portable CT with assessment of a dedicated head CT scanner.  AJNR Am J Neuroradiol. 2009;  30 1630-1636
  • 3 Kau C H, Richmond S, Palomo J M, Hans M G. Three-dimensional cone beam computerized tomography in orthodontics.  J Orthod. 2005;  32 (4) 282-293
  • 4 Chan Y, Siewerdsen J H, Rafferty M A, Moseley D J, Jaffray D A, Irish J C. Cone-beam computed tomography on a mobile C-arm: novel intraoperative imaging technology for guidance of head and neck surgery.  J Otolaryngol Head Neck Surg. 2008;  37 (1) 81-90
  • 5 Jackman A H, Palmer J N, Chiu A G, Kennedy D W. Use of intraoperative CT scanning in endoscopic sinus surgery: a preliminary report.  Am J Rhinol. 2008;  22 (2) 170-174
  • 6 Miracle A C, Mukherji S K. Conebeam CT of the head and neck, part 2: clinical applications.  AJNR Am J Neuroradiol. 2009;  30 (7) 1285-1292
  • 7 Rafferty M A, Siewerdsen J H, Chan Y et al.. Intraoperative cone-beam CT for guidance of temporal bone surgery.  Otolaryngol Head Neck Surg. 2006;  134 (5) 801-808
  • 8 Smith H E, Welsch M D, Sasso R C, Vaccaro A R. Comparison of radiation exposure in lumbar pedicle screw placement with fluoroscopy vs computer-assisted image guidance with intraoperative three-dimensional imaging.  J Spinal Cord Med. 2008;  31 (5) 532-537
  • 9 Bloom J D, Rizzi M D, Germiller J A. Real-time intraoperative computed tomography to assist cochlear implant placement in the malformed inner ear.  Otol Neurotol. 2009;  30 (1) 23-26
  • 10 Stieve M, Schwab B, Haupt C, Bisdas S, Heermann R, Lenarz T. Intraoperative computed tomography in otorhinolaryngology.  Acta Otolaryngol. 2006;  126 (1) 82-87
  • 11 Masaryk T, Kolonick R, Painter T, Weinreb D B. The economic and clinical benefits of portable head/neck CT imaging in the intensive care unit.  Radiol Manage. 2008;  30 (2) 50-54

Andrew J FishmanM.D. 

Northwestern University Feinberg School of Medicine

Chicago, IL 60611

Email: ajfishman@mac.com