Feasibility Assessment of Optical Coherence Tomography-Guided Laser Labeling in Middle Cranial Fossa Approach

Document Type : Original

Authors

1 Brain and Spinal cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran.

2 Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany.

3 Institute of Mechatronic Systems (IMES), Leibniz Universität Hannover, Hannover, Germany.

4 ENT Head and Neck Research Center and Department, Rasool Akram Hospital, Iran University of Medical Science, Tehran, Iran.

Abstract

Introduction:
Different approaches have been developed to find the position of the internal auditory canal (IAC)in middle cranial fossa approach. A feasibility study was performed to investigate the combination of cone beam computed tomography (CBCT), optical coherence tomography (OCT), and laser ablation to assist a surgeon in a middle cranial fossa approach by outlining the internal auditory canal (IAC).
 
Materials and Methods:
A combined OCT laser setup was used to outline the position of IAC on the surface of the petrous bone in cadaveric semi-heads. The position of the hidden structures, such as IAC, was determined in MATLAB software using an intraoperative CBCT scan. Four titanium spheres attached to the edge of the craniotomy served as reference markers visible in both CBCT and OCT images in order to transfer the plan to the patient. The integrated erbium-doped yttrium aluminum garnet laser was used to mark the surface of the bone by shallow ablation under OCT-based navigation before the surgeon continued the operation.
 
Result:
The technical setup was feasible, and the laser marking of the border of the IAC was performed with an overall accuracy of 300 μm. The depth of each ablation phase was 300 μm. The marks indicating a safe path supported the surgeon in the surgery.
 
Conclusion:
The technique investigated in the present study could decrease the surgical risks for the mentioned structures and improve the pace and precision of operation.

Keywords

Main Subjects

References

1. Aristegui M, Cokkeser Y, Saleh E, Naguib M, Landolfi M, Taibah A SM. the Extended Middle Cranial Fossa Approach. 1994; (September 1993): 181-8.
2. Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W, et al. Optical Coherence Tomography. Science (80)1991; 254: 1178-81.
3. Bornemann J, Hagner D, Brandenburg R, Wilkens L, Lenarz T & Hermann R. In vitro measurement conditions for optical coherence tomography (OCT). Acta Otolaryngol. 2006; 126(10):1084-90.doi:10.1080/00016480600672568.
4. Stübinger S. Advances in bone surgery: the Er : YAG laser in oral surgery and implant dentistry. Clin Cosmet Investig Dent. 2010 Jun; 30(2):47-62.
5. Ishikawa I, Aoki A, Takasaki AA. Clinical application of erbium:YAG laser in periodontology. J Int Acad Periodontol. 2008;10:22-30.
6. Ivanenko M, Werner M, Afilal S, Klasing M, Hering P. Ablation of hard bone tissue with pulsed CO2 lasers. Med Laser Appl. 2005;20(1):13-23. doi:10.1016/j.mla.2005.02.007.
7. Kahrs A. Bildverarbeitungsunterstützte Laserknochenablation Am HumanenFelsenbein. dissertation, Universität Fridericiana zu Karlsruhe,; 2009.
8. Díaz JD, Kundrat D, Goh KF, Majdani O, Ortmaier T. Towards intra-operative OCT guidance for automatic head surgery: first experimental results. Med Image Comput Comput Assist Interv. 2013;16(Pt 3):347-54.
9. Fuchs A, Pengel S, Bergmeier J, Kahrs A, Ortmaier T. Fast and automatic depthcontrol of iterative bone ablation based on optical coherence tomography data. Proc SPIE , Med Laser Appl Laser-Tissue Interact VII.95420.doi:10.1117/12. 2183695.
10. Diaz Day J. The Middle Fossa Approach and Extended Middle Fossa Approach:Technique and Operative Nuances. Operative Neurosurgery. 2012; 70 (ONS Suppl 2): 192–201.
11. Pau HW, Lankenau E, Just T, Behrend D, Hüttmann G. Optical coherence tomographyas an orientation guide in cochlear implant surgery? Acta Otolaryngol.2007;127(9):907-13.doi:10.1080/000 16480601089408.
12. Just T, Lankenau E, Hüttmann G, Pau HW. Optical coherence tomography of the ovalwindow niche. J Laryngol Otol. 2009;123:603-8.
13. Mohebbi S, Mirsalehi M, Kahrs L , Ortmaier T , Lenarz T ,Majdani O, Experimental Visualization of Labyrinthine Structure with Optical Coherence Tomography, Iranian Journal of Otorhinolaryngology, Vol.29(1), Serial No.90, Jan 2017.
14. Zhang Y, Pfeiffer T, Weller M, et al. Optical Coherence Tomography Guided Laser Cochleostomy : Towards the Accuracy on Tens of Micrometer Scale. Biomed Res Int.2014;2014.doi:10.1155/ 2014/251814.
15. Boppart SA, Herrmann J, Pitris C, Stamper DL, Brezinski ME, Fujimoto JG. High resolution optical coherence tomography-guided laser ablation of surgical tissue. J SurgRes. 1999;82:275-284. doi: 10. 1006/jsre.1998.5555.
16. Ohmi M, Ohnishi M, Takada D, Haruna M. Real-time OCT imaging of laser ablation of biological tissue. 2010. Proc. of SPIE (Optical Interactions with Tissues and Cells XXI,Francisco,California) Vol. 7562 756210-1, doi: 10.1117/12.840866
17. Goel RK, Kaouk JH. Optical coherence tomography: the past, present and future. JRobot Surg. 2007;1(3):179-184. doi:10.1007/s11701-007-0045-7.
18. Eilers H, Wienke M, Ortmaier T, Majdani O, Leinung M. Multimodal image registration of VCT and OCTimages: a step towards high accuracy in surgical navigation. Int J Comput Assist Radiol Surg. 2009;4(S1):124-33. doi:10.1007/s11548-009-0315-0.
19. Stopp S, Svejdar D, Von Kienlin E, Deppe H, Lueth TC. A new approach for creating defined geometries by navigated laser ablation based on volumetric 3-D data. IEEE TransBiomed Eng. 2008;55:1872-80. doi:10.1109/TBME.2008.919737.
20. Niemz MH. Laser-Tissue Interactions Fundamentals and Applications. 3rd ed. Berlin Heidelberg: Springer; 2007.
21. Eilers H, Baron S, Ortmaier T, Heimann B, Baier C, Rau Th,  et al. Navigated, robot assisted drilling of a minimally invasive cochlear access. 2009 IEEE Int Conf Mechatronics.2009:1-6.doi:10.1109/ICMECH.2009.4957213.
22. Caversaccio M, Stieger C, Weber S, Häusler R, Nolte L-P. Navigation and robotics of the lateral skull base. HNO. 2009;57(10):975-82.
23. Rumboldt Z, Huda W, All JW. Review of portable CT with assessment of a dedicated head CT scanner. Am J Neuroradiol. 2009;30:1630-6.
24. Miracle a C, Mukherji SK. Conebeam CT of the head and neck, part 2: clinical applications. AJNR Am J Neuroradiol. 2009;30(7):1285-92.
25. Leung BYC, Webster PJL, Fraser JM, Yang VXD. Real-time guidance of thermal and ultrashort pulsed laser ablation in hard tissue using inline coherent imaging. Lasers Surg Med. 2012;44(3):249-256. doi:10.1002/lsm.21162.
26. Fuchs A, Schultz M, Krüger A, Kundrat D, Díaz JD, Ortmaier T. Online measurement and evaluation of the Er : YAG laser ablation process using an integrated OCT system. Biomed Tech (Berl). 2012;57:434-7. doi:10.1515/bmt-2012-4231.
 
Iranian Journal of Otorhinolaryngology
Volume 30, Issue 6 - Serial Number 101
November and December 2018
Pages 321-327

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