3D Exoscope Navigation-Guided Approach to Middle Cranial Fossa

Area of Science:

• Neurosurgery
• Surgical Navigation
• Temporal Bone Anatomy

Background:

• The middle cranial fossa (MCF) approach is a standard surgical route to the internal auditory canal (IAC).
• Traditional MCF approaches rely on anatomical landmarks for dissection, which can be time-consuming and carry risks.
• Advancements in surgical navigation offer potential for increased precision and reduced reliance on landmarks.

Purpose of the Study:

• To evaluate the feasibility and efficacy of a 3D exoscope navigation-guided MCF approach to the IAC.
• To determine if navigation can obviate the need for dissection landmarks during IAC access.
• To assess the accuracy and safety of this novel technique.

Main Methods:

• Cadaveric dissection of six temporal bones was performed.
• Computed tomography (CT) of the temporal bone with fiducials was used for navigation setup.
• A 3D exoscope with Synaptive navigation system was employed for the MCF approach.

Main Results:

• Successful drilling of the IAC was achieved in all six specimens using the 3D exoscope.
• Navigation guided dissections eliminated the need to dissect the greater superficial petrosal nerve and superior semicircular canal.
• Mean navigation accuracy was 1.86 mm, demonstrating high precision.

Conclusions:

• A 3D exoscope navigation-guided MCF approach to the IAC is feasible.
• This technique can be performed without relying on traditional landmark dissection.
• Navigation guidance enhances precision and potentially simplifies the surgical approach to the IAC.