Transcanal Computed Tomography Views for Transcanal Endoscopic Lateral Skull Base Surgery: Pilot Cadaveric Study

Rory J. Lubner; Samuel R. Barber; Renata M. Knoll; Judith Kempfle; Daniel J. Lee; Katherine L. Reinshagen; Aaron K. Remenschneider; Elliott D. Kozin

doi:10.1055/s-0039-3400219

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2021; 82(03): 338-344
DOI: 10.1055/s-0039-3400219

Original Article

Transcanal Computed Tomography Views for Transcanal Endoscopic Lateral Skull Base Surgery: Pilot Cadaveric Study

Rory J. Lubner ‡^*

¹Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States

²Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States

,

Samuel R. Barber‡^*

¹Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States

³Department of Otolaryngology, University of Arizona College of Medicine, Tucson, Arizona, United States

,

Renata M. Knoll

¹Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States

⁴Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States

,

Judith Kempfle

¹Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States

⁴Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States

,

Daniel J. Lee

¹Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States

⁴Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States

,

Katherine L. Reinshagen

⁵Department of Radiology, Massachusetts Eye and Ear, Boston, Massachusetts, United States

,

Aaron K. Remenschneider

¹Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States

⁴Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States

⁶Department of Otolaryngology, University of Massachusetts Medical Center, Worcester, Massachusetts, United States

,

Elliott D. Kozin

¹Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States

⁴Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States

› Author Affiliations

Abstract

Objective Transcanal endoscopic operative approaches provide for a minimally invasive surgical portal to the lateral skull base. Traditional preoperative imaging evaluation involves computed tomography (CT) acquisition in the axial and coronal planes that are not optimized for the transcanal surgical corridor. Herein, we describe a novel CT-based “transcanal view” for preoperative surgical planning and intraoperative navigation.

Study Design Present study is a cadaveric imaging study.

Methods Cadaveric temporal bones (n = 6) from three specimens underwent high-resolution CT (0.625 mm slice thickness). Using three-dimensional (3D) Slicer 4.8, reformatted “transcanal” views in the plane of the external auditory canal (EAC) were created. Axial and coronal reformats were used to compare and measure distances between anatomic structures in the plane of the EAC.

Results The degree of oblique tilt for transcanal CT reformats was 6.67 ± 1.78 degrees to align the EAC in axial and coronal planes. Anticipated critical landmarks were identified easily using the transcanal view. Mean values were 8.68 ± 0.38 mm for annulus diameter, 9.5 ± 0.93 mm for isthmus diameter, 10.27 ± 0.73 mm for distance between annulus and isthmus, 2.95 ± 0.13 mm for distance between annulus and stapes capitulum, 5.12 ± 0.35 mm for distance between annulus and mastoid facial nerve, and 19.54 ± 1.22 mm for EAC length.

Conclusion This study is the first to illustrate a novel “transcanal” CT sequence intended for endoscopic lateral skull base surgery. Future studies may address how incorporation of a transcanal CT reformat may influence surgical decision making.

Keywords

lateral skull base surgery - endoscopic - computed tomography - preoperative planning - transcanal surgery

Full Text

References

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