Computer-assisted image-guided surgery in pediatric skull-base procedures

Skull-base surgery is characterized by the variety of important neural and vascular structures within a narrow operating field. Although preoperative imaging by computed tomography (CT) and magnetic resonance imaging (MRI) and the use of microsurgical techniques have improved intraoperative orientation, a large number of complications still are caused by localization problems. Especially in pediatric skull-base surgery, maximum localization accuracy during surgery is required. The authors developed a localizing system based on tomographic imaging (such as CT or MRI) to achieve safer surgery by providing highly accurate location information. The preliminary successful experience in the use of the Aachen computer-assisted surgery device for pediatric skull-base surgery (14 cases) is presented. Indication include juvenile angiofibroma of the nasopharynx, infectious and tumorous diseases of the paranasal sinuses, orbital tumors, foreign bodies, and intracranial abscess formation.