J Neurol Surg B Skull Base 2016; 77 - FP-07-03
DOI: 10.1055/s-0036-1592469

First Clinical Experience with Audiovisual Feedback during Navigated Temporal Bone Drilling

Eduard Voormolen 1, V. Topsakal 2, H. J. Noordmans 3, M. Viergever 4, L. Regli 5, J. W. Berkelbach van der Sprenkel 1
  • 1Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
  • 2Department of Otolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
  • 3Department of Clinical Physics, University Medical Center Utrecht, Utrecht, The Netherlands
  • 4Image Science Institute, University Medical Center Utrecht, Utrecht, The Netherlands
  • 5Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland

Background: New neuronavigation software (EVADE) was developed to avoid damage to critical anatomical structures during skull base drilling by 1) virtually visualizing bone drilling, and 2) providing audiovisual warnings when the drill tip enters a protective perimeter set at a distance around these structures. Previously, we validated EVADE in phantom and cadaver studies.

Aim: To present our initial clinical experience with these two special audiovisual feedback techniques during temporal bone drilling.

Methods: Four patients who received skull base surgery at our institution were included. Case details were recorded. We evaluated drill damage to temporal bone structures, clinical outcome at 30 days post-operatively and performance of the software via surgeon questionnaires.

Results: Two patients had an anterior petrosectomy and a retrolabyrinthine combined approach for petroclival meningoma, and two patients had mastoidectomy for plugging of superior semicircular canal dehiscence. No structures protected by audiovisual warnings were damaged during drilling. 30-day clinical outcomes were good. Surgeons thought EVADE performed well and had added value over standard neuronavigation during these procedures.

Conclusion: We demonstrate clinical feasibility of the EVADE software and its audiovisual feedback might have added value to surgeons during temporal bone drilling.