A novel approach to skull‐base and orbital osteotomies through virtual planning and navigation

ObjectiveComputer-assisted planning of osteotomy lines, coupled with navigation-guided performance of planned osteotomies, is a highly innovative approach to skull-base and orbital surgery. The aim of this pilot study is to provide an assessment of the accuracy of this novel approach in guiding the correct positioning of osteotomy lines in frontal, temporal, and orbital regions, defining the agreement between the spatial position of the planned and performed osteotomies.MethodsFifteen patients with orbital, frontal sinus, and lateral skull-base diseases underwent virtual surgical planning. Osteotomies to access the orbit, frontal sinus, and lateral skull base were planned on computer tomography-based three-dimensional models. The planned osteotomies were reproduced on the operating field using a navigation system. The positions of the performed and planned osteotomies were compared. The results were described as the mean positional difference between planned and performed osteotomies and as Lin's concordance coefficient, and Bland-Altman limits of agreement were also defined.ResultsThe overall mean difference was 0.719mm (95% confidence interval [CI]: 0.472 to 0.965mm). Overall, Lin's concordance coefficient was 0.997 (95% CI: 0.996 to 0.998), and overall Bland-Altman limits of agreement ranged from -1.407 to 2.844mm. The smallest mean difference (0.587mm, 95% CI: 0.244 to 0.931mm) was calculated in the orbit group, whereas the highest mean difference (0.904mm, 95% CI: 0.428 to 1.379mm) was described in the lateral skull-base group.ConclusionThis study's results support the use of this novel planning and navigation protocol for guiding osteotomy in anterior and lateral skull-base surgery, providing a clinical validation of this technique.Level of Evidence4 Laryngoscope, 00:1-9, 2018 Laryngoscope, 129:823-831, 2019