Real-time imaging with the o-arm for skull base applications: a cadaveric feasibility study

Area of Science:

• Neurosurgery
• Medical Imaging
• Anatomy

Background:

• Intraoperative imaging and navigation are crucial in neurosurgery but limited in cranial base surgery.
• Poor bony resolution and accuracy necessitate reliance on potentially distorted anatomic landmarks.
• The O-Arm, a fluoroscopic device, was investigated for its potential to overcome these limitations.

Purpose of the Study:

• To evaluate the accuracy and utility of the O-Arm for intraoperative navigation in cranial base surgery.
• To assess the O-Arm's ability to provide necessary imaging resolution at the skull base.
• To compare preplanned landmark identification with direct visualization during surgical approaches.

Main Methods:

• A cadaveric study using the O-Arm for 3D cone-beam imaging.
• Registration of O-Arm scans with the Stealth S7 navigation system.
• Identification of key cranial base landmarks via endoscopic endonasal and middle fossa approaches.
• Quantification of the error between preplanned and identified structures.

Main Results:

• Mean errors for anterior cranial fossa landmarks ranged from 0.25 to 0.32 mm.
• Mean errors for middle fossa landmarks ranged from 0.11 to 0.44 mm.
• The O-Arm demonstrated high accuracy for critical skull base structures.

Conclusions:

• The O-Arm provides sufficient imaging resolution for intraoperative navigation in cranial base surgery.
• This technology can enhance accuracy in both open and endoscopic cranial base approaches.
• Further clinical investigation is warranted to confirm efficacy in patient procedures.