A HYBRID APPROACH TO MINIMALLY INVASIVE CRANIOMAXILLOFACIAL SURGERY: VIDEOENDOSCOPIC-ASSISTED INTERVENTIONS WITH IMAGE-GUIDED NAVIGATION

摘要

The application of minimally invasive approaches in terms of complex craniomaxillo-facial procedures requires an advanced technology comprising image data based surgical navigation. In addition, an increased experience with endoscopically-assisted and navigationally-guidcd techniques, as well as the development of dedicated instruments, has opened access for minimally invasive procedures to the craniofacial region. One such option is the hybrid approach to craniomaxillofacial and plastic surgery. This combines minimally invasive endoscopic techniques with image-guided surgical navigation technology. For assessment of the performance of surgical navigation thirty-eight patients covering a broad range of treatment indications were scheduled for image-guided surgery by use of a wireless passive infrared surgical navigation system (VectorVisionTM, BrainLAB). The preoperative computed tomography (CT) data was obtained prior surgery. Patient-to-image registration was performed by laser surface scanning. The registration accuracy was expressed by a calculated value, the root mean square (RMS). The system has been used for endoscopically assisted surgery, for the insertion of dental and craniofacial implants, for the reduction of complex midfacial trauma, for skull bone tumor removals and further miscellaneous interventions. The overall mean accuracy (RMS) was 1.24 (SD: 0.58). Preliminary outcome of patients receiving hybrid approach technology has been remarkably positive. Image guidance offers helpful assistance especially in cases with complex anatomy, Despite some limitation, many craniomaxillofacial problems can be solved safely and effectively.