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Fehlerquellen der Navigation in der lateralen Schädelbasischirurgie

Darstellung von Einflussfaktoren in der Praxis

Common errors of intraoperative navigation in lateral skull base surgery

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Zusammenfassung

Hintergrund und Fragestellung.

Die Identifikation möglicher Störfaktoren navigationsunterstützter Eingriffe an der lateralen Schädelbasis ermöglichen dem Anwender die Vermeidung und Behebung dieser Fehler.

Patienten/Methodik.

Anhand unserer Erfahrungen von 85 navigationsunterstützten Eingriffen im Bereich der lateralen Schädelbasis werden Fehler der Hard- und Software, der Bildgebung und des -transfers, der Patientenregistrierung, durch den Anwender und solche strategischer Art analysiert.

Ergebnisse.

Bei optischen CAS-Systemen führt eine Blockade des Sichtfelds der Kameras zu Funktionsbeschränkungen, während elektromagnetische Systeme durch ferromagnetisch aktive Materialien beeinflusst werden können. Die bisherigen Verfahren der Patientenregistrierung stellen neben einer fehlenden Kompensation der Weichteilverschiebung ("soft tissue shift") ein Kernproblem dar.

Schlussfolgerungen.

Ein kritischer Umgang mit Navigationssystemen im Bereich der Chirurgie der lateralen Schädelbasis befähigt den Anwender, Anzeichen einer Fehlfunktion zu erkennen und richtig zu interpretieren. Eine dadurch resultierende Vorwarnzeit hilft, den Erfolg einer navigationsunterstützten Operation zu sichern.

Abstract

Background and Objective.

The knowledge of disturbing factors for navigated surgical procedures in lateral skull base surgery will help the user to identify, avoid, and correct these errors.

Patients/Methods.

Based on our experiences with 85 patients undergoing surgery of the lateral skull base, errors of hard- and software, of image acquisition and image transfer, of patient registration, user-related errors as well as strategic errors were analyzed.

Results.

Any impairment of the camera field leads to functional limitation of optical systems to the same extent as electromagnetic systems can be affected by ferromagnetic materials. Standard patient registration procedures as well as the lack of compensation for soft tissue shift may cause problems.

Conclusions.

While dealing with navigation devices in lateral skull base surgery, the user must pay critical attention to certain details in order to recognize and interpret possible malfunction.

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Author notes

  1. U. Ecke

    Present address: Univ.-HNO-Klinik, Mainz, Langenbeckstraße 1, 55101, Deutschland

Authors and Affiliations

  1. Univ.-HNO-Klinik der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland

    U. Ecke, J. Maurer, M. Khan & W. J. Mann

  2. Institut für Neuroradiologie der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland

    S. Boor

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  1. U. Ecke
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  2. J. Maurer
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  3. S. Boor
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  4. M. Khan
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  5. W. J. Mann
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Correspondence to U. Ecke.

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Ecke, U., Maurer, J., Boor, S. et al. Fehlerquellen der Navigation in der lateralen Schädelbasischirurgie. HNO 51, 386–393 (2003). https://doi.org/10.1007/s00106-002-0738-1

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