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. 2018 Oct 29;2(4):2473974X18804492.
doi: 10.1177/2473974X18804492. eCollection 2018 Oct-Dec.

Augmented Reality, Surgical Navigation, and 3D Printing for Transcanal Endoscopic Approach to the Petrous Apex

Samuel R Barber  1   2 , Kevin Wong  2   3 , Vivek Kanumuri  3   4 , Ruwan Kiringoda  3   4 , Judith Kempfle  3   4 , Aaron K Remenschneider  2 , Elliott D Kozin  3   4 , Daniel J Lee  3   4
Affiliations

Augmented Reality, Surgical Navigation, and 3D Printing for Transcanal Endoscopic Approach to the Petrous Apex

Samuel R Barber et al. OTO Open. .

Abstract

Otolaryngologists increasingly use patient-specific 3-dimensional (3D)-printed anatomic physical models for preoperative planning. However, few reports describe concomitant use with virtual models. Herein, we aim to (1) use a 3D-printed patient-specific physical model with lateral skull base navigation for preoperative planning, (2) review anatomy virtually via augmented reality (AR), and (3) compare physical and virtual models to intraoperative findings in a challenging case of a symptomatic petrous apex cyst. Computed tomography (CT) imaging was manually segmented to generate 3D models. AR facilitated virtual surgical planning. Navigation was then coupled to 3D-printed anatomy to simulate surgery using an endoscopic approach. Intraoperative findings were comparable to simulation. Virtual and physical models adequately addressed details of endoscopic surgery, including avoidance of critical structures. Complex lateral skull base cases may be optimized by surgical planning via 3D-printed simulation with navigation. Future studies will address whether simulation can improve patient outcomes.

Keywords: 3D printing; augmented reality; endoscopic; navigation; residency education; simulation; skull base; transcanal.

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Figures

Figure 1.
Figure 1.
Left ear 3-dimensional (3D) reconstruction. (A) Manual segmentation from computed tomography images into 3D meshes using ITK-SNAP. (B, C) Augmented reality mobile phone application visualized anatomy preoperatively, registered with target image. FN, facial nerve; ICA, internal carotid artery; JB, jugular bulb; PAC, petrous apex cyst; SCC, semicircular canal; SS, sigmoid sinus.
Figure 2.
Figure 2.
(A) A 3-dimensional (3D) print of temporal bone used for preoperative simulation. (B) Computed tomography scan of a 3D print was a 1:1 match with the original and able to be registered for navigation. (C) Transcanal approach to petrous apex was simulated on 3D print with navigation.
Figure 3.
Figure 3.
(A) Intraoperative photo of the live surgery performed using a transcanal endoscopic approach. (B) Comparison of intraoperative (upper panel) with virtual, preoperative otoendoscopic views (lower panel) demonstrated that the virtual render predicted the trajectory of the real surgical approach based on structures at risk: (a) internal carotid artery, (b) jugular bulb, (c) basal turn of the cochlea, and (d) access to petrous apex cyst.
See this image and copyright information in PMC

References

    1. Hoang D, Perrault D, Stevanovic M, et al. Surgical applications of three-dimensional printing: a review of the current literature & how to get started. Ann Transl Med. 2016;4:456. - PMC - PubMed
    1. Crafts TD, Ellsperman SE, Wannemuehler TJ, et al. Three-dimensional printing and its applications in otorhinolaryngology–head and neck surgery. Otolaryngol Head Neck Surg. 2017;156:999-1010. - PubMed
    1. Hsieh TY, Dedhia R, Cervenka B, et al. 3D Printing: current use in facial plastic and reconstructive surgery. Curr Opin Otolaryngol Head Neck Surg. 2017;25:291-299. - PubMed
    1. Mendez BM, Chiodo MV, Patel PA. Customized “in-office” three-dimensional printing for virtual surgical planning in craniofacial surgery. J Craniofac Surg. 2015;26:1584-1586. - PubMed
    1. Kaye R, Goldstein T, Zeltsman D, et al. Three dimensional printing: a review on the utility within medicine and otolaryngology. Int J Pediatr Otorhinolaryngol. 2016;89:145-148. - PubMed