Navigation-Guided Transnasal Endoscopic Delineation of the Posterior Margin for Maxillary Sinus Cancers: A Preclinical Study
BackgroundThe resection of advanced maxillary sinus cancers can be challenging due to the anatomical proximity to surrounding critical anatomical structures. Transnasal endoscopy can effectively aid the delineation of the posterior margin of resection. Implementation with 3D-rendered surgical naviga...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:e2248754c77247fcbcc5bc3a65efeb202021-11-11T08:59:15ZNavigation-Guided Transnasal Endoscopic Delineation of the Posterior Margin for Maxillary Sinus Cancers: A Preclinical Study2234-943X10.3389/fonc.2021.747227https://doaj.org/article/e2248754c77247fcbcc5bc3a65efeb202021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.747227/fullhttps://doaj.org/toc/2234-943XBackgroundThe resection of advanced maxillary sinus cancers can be challenging due to the anatomical proximity to surrounding critical anatomical structures. Transnasal endoscopy can effectively aid the delineation of the posterior margin of resection. Implementation with 3D-rendered surgical navigation with virtual endoscopy (3D-SNVE) may represent a step forward. This study aimed to demonstrate and quantify the benefits of this technology.Material and MethodFour maxillary tumor models with critical posterior extension were created in four artificial skulls (Sawbones®). Images were acquired with cone-beam computed tomography and the tumor and carotid were contoured. Eight head and neck surgeons were recruited for the simulations. Surgeons delineated the posterior margin of resection through a transnasal approach and avoided the carotid while establishing an adequate resection margin with respect to tumor extirpation. Three simulations were performed: 1) unguided: based on a pre-simulation study of cross-sectional imaging; 2) tumor-guided: guided by real-time tool tracking with 3D tumor and carotid rendering; 3) carotid-guided: tumor-guided with a 2-mm alert cloud surrounding the carotid. Distances of the planes from the carotid and tumor were classified as follows and the points of the plane were classified accordingly: “red”: through the carotid artery; “orange”: <2 mm from the carotid; “yellow”: >2 mm from the carotid and within the tumor or <5 mm from the tumor; “green”: >2 mm from the carotid and 5–10 mm from the tumor; and “blue”: >2 mm from the carotid and >10 mm from the tumor. The three techniques (unguided, tumor-guided, and carotid-guided) were compared.Results3D-SNVE for the transnasal delineation of the posterior margin in maxillary tumor models significantly improved the rate of margin-negative clearance around the tumor and reduced damage to the carotid artery. “Green” cuts occurred in 52.4% in the unguided setting versus 62.1% and 64.9% in the tumor- and carotid-guided settings, respectively (p < 0.0001). “Red” cuts occurred 6.7% of the time in the unguided setting versus 0.9% and 1.0% in the tumor- and carotid-guided settings, respectively (p < 0.0001).ConclusionsThis preclinical study has demonstrated that 3D-SNVE provides a substantial improvement of the posterior margin delineation in terms of safety and oncological adequacy. Translation into the clinical setting, with a meticulous assessment of the oncological outcomes, will be the proposed next step.Stefano TaboniStefano TaboniStefano TaboniStefano TaboniStefano TaboniMarco FerrariMarco FerrariMarco FerrariMarco FerrariMarco FerrariMichael J. DalyHarley H. L. ChanDonovan EuDonovan EuTommaso GualtieriTommaso GualtieriTommaso GualtieriAshok R. JethwaAxel SahovalerAxel SahovalerAxel SahovalerAndrew SewellWael HasanWael HasanIlyes BeraniaJimmy QiuJohn de AlmeidaPiero NicolaiRalph W. GilbertJonathan C. IrishJonathan C. IrishFrontiers Media S.A.articleintraoperative navigation (NIV)3D-virtual endoscopysurgical marginsmaxillary sinus cancerstransnasal endoscopic surgeryNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
intraoperative navigation (NIV) 3D-virtual endoscopy surgical margins maxillary sinus cancers transnasal endoscopic surgery Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 |
| spellingShingle |
intraoperative navigation (NIV) 3D-virtual endoscopy surgical margins maxillary sinus cancers transnasal endoscopic surgery Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Stefano Taboni Stefano Taboni Stefano Taboni Stefano Taboni Stefano Taboni Marco Ferrari Marco Ferrari Marco Ferrari Marco Ferrari Marco Ferrari Michael J. Daly Harley H. L. Chan Donovan Eu Donovan Eu Tommaso Gualtieri Tommaso Gualtieri Tommaso Gualtieri Ashok R. Jethwa Axel Sahovaler Axel Sahovaler Axel Sahovaler Andrew Sewell Wael Hasan Wael Hasan Ilyes Berania Jimmy Qiu John de Almeida Piero Nicolai Ralph W. Gilbert Jonathan C. Irish Jonathan C. Irish Navigation-Guided Transnasal Endoscopic Delineation of the Posterior Margin for Maxillary Sinus Cancers: A Preclinical Study |
| description |
BackgroundThe resection of advanced maxillary sinus cancers can be challenging due to the anatomical proximity to surrounding critical anatomical structures. Transnasal endoscopy can effectively aid the delineation of the posterior margin of resection. Implementation with 3D-rendered surgical navigation with virtual endoscopy (3D-SNVE) may represent a step forward. This study aimed to demonstrate and quantify the benefits of this technology.Material and MethodFour maxillary tumor models with critical posterior extension were created in four artificial skulls (Sawbones®). Images were acquired with cone-beam computed tomography and the tumor and carotid were contoured. Eight head and neck surgeons were recruited for the simulations. Surgeons delineated the posterior margin of resection through a transnasal approach and avoided the carotid while establishing an adequate resection margin with respect to tumor extirpation. Three simulations were performed: 1) unguided: based on a pre-simulation study of cross-sectional imaging; 2) tumor-guided: guided by real-time tool tracking with 3D tumor and carotid rendering; 3) carotid-guided: tumor-guided with a 2-mm alert cloud surrounding the carotid. Distances of the planes from the carotid and tumor were classified as follows and the points of the plane were classified accordingly: “red”: through the carotid artery; “orange”: <2 mm from the carotid; “yellow”: >2 mm from the carotid and within the tumor or <5 mm from the tumor; “green”: >2 mm from the carotid and 5–10 mm from the tumor; and “blue”: >2 mm from the carotid and >10 mm from the tumor. The three techniques (unguided, tumor-guided, and carotid-guided) were compared.Results3D-SNVE for the transnasal delineation of the posterior margin in maxillary tumor models significantly improved the rate of margin-negative clearance around the tumor and reduced damage to the carotid artery. “Green” cuts occurred in 52.4% in the unguided setting versus 62.1% and 64.9% in the tumor- and carotid-guided settings, respectively (p < 0.0001). “Red” cuts occurred 6.7% of the time in the unguided setting versus 0.9% and 1.0% in the tumor- and carotid-guided settings, respectively (p < 0.0001).ConclusionsThis preclinical study has demonstrated that 3D-SNVE provides a substantial improvement of the posterior margin delineation in terms of safety and oncological adequacy. Translation into the clinical setting, with a meticulous assessment of the oncological outcomes, will be the proposed next step. |
| format |
article |
| author |
Stefano Taboni Stefano Taboni Stefano Taboni Stefano Taboni Stefano Taboni Marco Ferrari Marco Ferrari Marco Ferrari Marco Ferrari Marco Ferrari Michael J. Daly Harley H. L. Chan Donovan Eu Donovan Eu Tommaso Gualtieri Tommaso Gualtieri Tommaso Gualtieri Ashok R. Jethwa Axel Sahovaler Axel Sahovaler Axel Sahovaler Andrew Sewell Wael Hasan Wael Hasan Ilyes Berania Jimmy Qiu John de Almeida Piero Nicolai Ralph W. Gilbert Jonathan C. Irish Jonathan C. Irish |
| author_facet |
Stefano Taboni Stefano Taboni Stefano Taboni Stefano Taboni Stefano Taboni Marco Ferrari Marco Ferrari Marco Ferrari Marco Ferrari Marco Ferrari Michael J. Daly Harley H. L. Chan Donovan Eu Donovan Eu Tommaso Gualtieri Tommaso Gualtieri Tommaso Gualtieri Ashok R. Jethwa Axel Sahovaler Axel Sahovaler Axel Sahovaler Andrew Sewell Wael Hasan Wael Hasan Ilyes Berania Jimmy Qiu John de Almeida Piero Nicolai Ralph W. Gilbert Jonathan C. Irish Jonathan C. Irish |
| author_sort |
Stefano Taboni |
| title |
Navigation-Guided Transnasal Endoscopic Delineation of the Posterior Margin for Maxillary Sinus Cancers: A Preclinical Study |
| title_short |
Navigation-Guided Transnasal Endoscopic Delineation of the Posterior Margin for Maxillary Sinus Cancers: A Preclinical Study |
| title_full |
Navigation-Guided Transnasal Endoscopic Delineation of the Posterior Margin for Maxillary Sinus Cancers: A Preclinical Study |
| title_fullStr |
Navigation-Guided Transnasal Endoscopic Delineation of the Posterior Margin for Maxillary Sinus Cancers: A Preclinical Study |
| title_full_unstemmed |
Navigation-Guided Transnasal Endoscopic Delineation of the Posterior Margin for Maxillary Sinus Cancers: A Preclinical Study |
| title_sort |
navigation-guided transnasal endoscopic delineation of the posterior margin for maxillary sinus cancers: a preclinical study |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/e2248754c77247fcbcc5bc3a65efeb20 |
| work_keys_str_mv |
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