Intraoperative Accurate Automatic Modeling of Skull Defects with Neuronavigation System

  • Yangjie Xie
  • Rongqian YangEmail author
Conference paper
Part of the Communications in Computer and Information Science book series (CCIS, volume 1072)


Reconstruction and repair of skull defects is a very important step for the prognosis of patients in skull base surgery. However, different surgical approaches will cause different surgical defects for patients, and it is difficult to accurately reconstruct the three-dimensional (3D) structure of the skull defects for complicated structures approaches such as the trans-eyebrow approach. This study aims at proposing a method with surgical navigation system for accurately and instantly obtaining the structure of skull defect resulting from craniotomies, which is important for skull repairing. CT scanning is completed and the skull is segmented in the preoperative operation plan. After completing the craniotomy approach operation, the surgeon uses the surgical probe to trace along the edge of the skull defect while the navigation system records the three-dimensional coordinates of the probe tip in real time, and the direction of the main view direction is also recorded. With above information, the structure of defect skull can be reconstructed automatically according to the preoperative segmented skull information. The method using the preoperative image scanning data and intraoperative navigation data to get the structure of the defect skull is accurate and rapid.


Skull base surgery Skull defect reconstruction Navigation system 


  1. 1.
    Badie, B., Preston, J.K., Hartig, G.K.: Use of titanium mesh for reconstruction of large anterior cranial base defects. J. Neurosurg. 93(4), 711–714 (2000)CrossRefGoogle Scholar
  2. 2.
    Cao, A., et al.: Laser range scanning for image-guided neurosurgery: investigation of image-to-physical space registrations. Med. Phys. 35(4), 1593–1605 (2008)CrossRefGoogle Scholar
  3. 3.
    Eseonu, C.I., et al.: Reduced CSF leak in complete calvarial reconstructions of microvascular decompression craniectomies using calcium phosphate cement. J. Neurosurg. 123(6), 1476 (2015)CrossRefGoogle Scholar
  4. 4.
    Essayed, W.I., Singh, H., Lapadula, G., Almodovar-Mercado, G.J., Anand, V.K., Schwartz, T.H.: Endoscopic endonasal approach to the ventral brainstem: anatomical feasibility and surgical limitations. J. Neurosurg. 78(S 01), 1–8 (2017)Google Scholar
  5. 5.
    Essayed, W.I., et al.: 3D printing and intraoperative neuronavigation tailoring for skull base reconstruction after extended endoscopic endonasal surgery: proof of concept. J. Neurosurg. 79(S 01), 1 (2018)Google Scholar
  6. 6.
    Harvey, R.J., Priscilla, P., Raymond, S., Zanation, A.M.: Endoscopic skull base reconstruction of large dural defects: a systematic review of published evidence. Laryngoscope 122(2), 452–459 (2012)CrossRefGoogle Scholar
  7. 7.
    Luginbuhl, A.J., Campbell, P.G., James, E., Marc, R.: Endoscopic repair of high-flow cranial base defects using a bilayer button. Laryngoscope 120(5), 876–880 (2010)Google Scholar
  8. 8.
    Luigi Maria, C., et al.: Skull base reconstruction in the extended endoscopic transsphenoidal approach for suprasellar lesions. J. Neurosurg. 107(4), 713–720 (2007)CrossRefGoogle Scholar
  9. 9.
    Marmulla, R., Eggers, G.J.: Laser surface registration for lateral skull base surgery. Minim. Invasive Neurosurg. 48(03), 181–185 (2005)CrossRefGoogle Scholar
  10. 10.
    Nicolas, G., et al.: High-accuracy patient-to-image registration for the facilitation of image-guided robotic microsurgery on the head. IEEE Trans. Biomed. Eng. 60(4), 960–968 (2013)CrossRefGoogle Scholar
  11. 11.
    Raza, S.M., Banu, M.A., Donaldson, A., Patel, K.S., Anand, V.K., Schwartz, T.H.: Sensitivity and specificity of intrathecal fluorescein and white light excitation for detecting intraoperative cerebrospinal fluid leak in endoscopic skull base surgery: a prospective study. J. Neurosurg. 124(3), 621 (2016)CrossRefGoogle Scholar
  12. 12.
    Rüdiger, M., Stefan, H., Tim, L., Joachim, M.: Laser-scan-based navigation in cranio-maxillofacial surgery. J. Cranio-Maxillofac. Surg. 31(5), 267–277 (2003)CrossRefGoogle Scholar
  13. 13.
    Rüdiger, M., Tim, L., Joachim, M., Stefan, H.: Markerless laser registration in image-guided oral and maxillofacial surgery. J. Oral Maxillofac. Surg. Off. J. Am. Assoc. Oral Maxillofac. Surg. 62(7), 845–851 (2004)CrossRefGoogle Scholar
  14. 14.
    Sivashanmugam, D., Negm, H.M., Salomon, C., Anand, V.K., Schwartz, T.H.: Endonasal endoscopic transsphenoidal resection of tuberculum sella meningioma with anterior cerebral artery encasement. Cureus 7(8), e311 (2015)Google Scholar
  15. 15.
    Sunil, M., Mark, W., Semaan, M.T., Megerian, C.A., Bambakidis, N.C.: Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh-hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma. J. Neurosurg. 119(1), 113–120 (2013)CrossRefGoogle Scholar
  16. 16.
    Victor, G.N., Anand, V.K., Schwartz, T.H.: Gasket seal closure for extended endonasal endoscopic skull base surgery: efficacy in a large case series. World Neurosurg. 80(5), 563–568 (2013)CrossRefGoogle Scholar
  17. 17.
    Zwagerman, N.T., et al.: Endoscopic transnasal skull base surgery: pushing the boundaries. J. Neurooncol. 130(2), 319–330 (2016)CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Biomedical EngineeringSouth China University of TechnologyGuangzhouChina
  2. 2.Department of Therapeutic RadiologyYale UniversityNew HavenUSA

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