Quantitative Analysis of Surgical Working Space during Endoscopic Skull Base Surgery
Notice bibliographique
Résumé
Background The transsphenoidal endoscopic approach has widely been accepted as standard practice for accessing the majority of tumors of the skull base. Over the years, varying approaches have been described to improve visualization and maximize working space within the sinonasal corridor. Specifically, the approach may include a limited or wide posterior septectomy and the partial resection of one or both middle turbinates. No study to date has quantitatively assessed the improvement in the overall distance of working space, and distance between instruments/endoscope with these various maneuvers. Our study sought to calculate these measurements and determine the sequential quantitative improvement in working space. Methods Following placement of fiducial markers, cone beam computed tomography (CT) scans of four cadaveric heads were obtained for registration of an optical tracking system with calibrated tracked endoscope and pointer. The nasal sill was defined as the primary reference point for all measurements. Each head was sequentially dissected: (1) sphenoidotomy and limited posterior septectomy, (2) unilateral middle turbinectomy, (3) bilateral middle turbinectomy, and (4) wide posterior septectomy. After each subsequent dissection, the maximal craniocaudal and mediolateral distance (mm) and angles (degrees) reached by an optical tracker was calculated at the level of the sphenoid face and sella, first through the left, and then right nare. These measurements were collected both with optical tracking via CT guidance, and under direct visualization with an endoscope. In two specimens, an additional measurement of the distance between the pointer and the tip of the endoscope was calculated. Statistical analysis was completed using SPSS 17.0. Results With each subsequent dissection, a significant improvement in access, both craniocaudal (17 ± 3; 20 ± 3; 22 ± 10; and 22 ± 5 mm) and mediolateral distances (21 ± 3; 24 ± 3 mm; 26 ± 3; and 29 ± 5 mm), was observed at the level of the sphenoid face ( p < 0.05). This same effect was observed at the level of the sella in the mediolateral dimension (23 ± 4 vs. 20 ± 4 mm; p < 0.05) with wide posterior septectomy, but not for uni- or bilateral middle turbinectomy. A small increase in the craniocaudal and mediolateral angles was observed at the level of the sphenoid face and sella with each subsequent dissection, but did not reach significance. A significant improvement in the mean distance between the optical tracking pointer and endoscope (sphenoid: 47 ± 10 mm; sella: 72 ± 8 mm) was found when a wide posterior septectomy was performed compared with limited posterior septectomy (sphenoid: 18 ± 2 mm; sella: 37 ± 5 mm) ( p < 0.001). This effect was not observed for either uni- or bilateral middle turbinectomy. Overall, the side and degree of visualization (blind or direct visualization) had no impact on any of the measurements. Conclusion Compared with limited posterior septectomy, resection of uni- or bilateral middle turbinates, and/or performing a wide posterior septectomy, maximizes access for working at the level of the skull base. In addition, a wide posterior septectomy will enhance the field of view by permitting a greater distance between working surgical instruments and the endoscope.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».