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Automated objective surgical planning for lateral skull base tumors

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Surgical removal of pathology at the lateral skull base is challenging because of the proximity of critical anatomical structures which can lead to significant morbidity when damaged or traversed. Pre-operative computed surgical approach planning has the potential to aid in selection of the optimal approach to remove pathology and minimize complications.

Methods

We propose an automated surgical approach planning algorithm to derive the optimal approach to vestibular schwannomas in the internal auditory canal for hearing preservation surgery. The algorithm selects between the middle cranial fossa and retrosigmoid approach by utilizing a unique segmentation of each patient’s anatomy and a cost function to minimize potential surgical morbidity.

Results

Patients who underwent hearing preservation surgery for vestibular schwannoma resection (n = 9) were included in the cohort. Middle cranial fossa surgery was performed in 5 patients, and retrosigmoid surgery was performed in 4. The algorithm favored the performed surgical approach in 6 of 9 patients.

Conclusion

We developed a method for computing morbidity costs of surgical paths to objectively analyze surgical approaches at the lateral skull base. Computed pre-operative planning may assist in surgical decision making, trainee education, and improving clinical outcomes.

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Availability of data and material

Data used for this study are currently not publicly available.

Code availability

Code is available per request to authors.

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Acknowledgements

Jason R. Crossley assisted in manuscript preparation.

Funding

Partial financial support was received from the Center for Translational Research–Clinical Research Scholars Program at Seattle Children’s Hospital.

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Authors and Affiliations

  1. University of Washington School of Medicine, Seattle, WA, USA

    A. E. Rajesh

  2. Department of Otolaryngology—Head and Neck Surgery, University of Washington, Seattle, WA, USA

    J. T. Rubinstein, R. A. Bly & G. D. Kohlberg

  3. Department of Neurological Surgery, University of Washington, Seattle, WA, USA

    M. Ferreira & A. P. Patel

  4. Seattle Children’s Hospital and Research Institute, Seattle, WA, USA

    R. A. Bly

Authors
  1. A. E. Rajesh
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  2. J. T. Rubinstein
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  3. M. Ferreira
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  4. A. P. Patel
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  5. R. A. Bly
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  6. G. D. Kohlberg
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Corresponding authors

Correspondence to R. A. Bly or G. D. Kohlberg.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

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Approval for the study was obtained by the University of Washington Institutional Review Board.

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All patient imaging was de-identified.

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Rajesh, A.E., Rubinstein, J.T., Ferreira, M. et al. Automated objective surgical planning for lateral skull base tumors. Int J CARS 17, 427–436 (2022). https://doi.org/10.1007/s11548-022-02564-9

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  • DOI: https://doi.org/10.1007/s11548-022-02564-9

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