Automated objective surgical planning for lateral skull base tumors

• Published in: International journal for computer assisted radiology and surgery Vol. 17; no. 3; pp. 427 - 436
• Main Authors: Rajesh, A. E., Rubinstein, J. T., Ferreira, M., Patel, A. P., Bly, R. A., Kohlberg, G. D.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.03.2022; Springer Nature B.V
• Subjects: Algorithms; Automation; Computer Imaging; Computer Science; Cost analysis; Cost function; Decision making; Ear; Ear, Inner; Health Informatics; Hearing; Humans; Imaging; Medicine; Medicine & Public Health; Morbidity; Neuroma, Acoustic - diagnostic imaging; Neuroma, Acoustic - surgery; Original Article; Pathology; Pattern Recognition and Graphics; Postoperative Complications; Radiology; Retrospective Studies; Segmentation; Skull Base - diagnostic imaging; Skull Base - surgery; Skull Base Neoplasms - complications; Skull Base Neoplasms - diagnostic imaging; Skull Base Neoplasms - surgery; Surgery; Vision; Temporal bone; Planning; Preoperative; Skull base; Surgery; Approach
• ISSN: 1861-6410; 1861-6429; 1861-6429
• DOI: 10.1007/s11548-022-02564-9

Purpose Surgical removal of pathology at the lateral skull base is challenging because of the proximity of critical anatomical structures which can lead to significant morbidity when damaged or traversed. Pre-operative computed surgical approach planning has the potential to aid in selection of the optimal approach to remove pathology and minimize complications. Methods We propose an automated surgical approach planning algorithm to derive the optimal approach to vestibular schwannomas in the internal auditory canal for hearing preservation surgery. The algorithm selects between the middle cranial fossa and retrosigmoid approach by utilizing a unique segmentation of each patient’s anatomy and a cost function to minimize potential surgical morbidity. Results Patients who underwent hearing preservation surgery for vestibular schwannoma resection (n = 9) were included in the cohort. Middle cranial fossa surgery was performed in 5 patients, and retrosigmoid surgery was performed in 4. The algorithm favored the performed surgical approach in 6 of 9 patients. Conclusion We developed a method for computing morbidity costs of surgical paths to objectively analyze surgical approaches at the lateral skull base. Computed pre-operative planning may assist in surgical decision making, trainee education, and improving clinical outcomes.