3d Printed Model , Virtual Navigation and Endoscopic Infracochlear Approach for Drainage of Petrous Apex Cholesterol Granulomas

By June 7, 2019

Prieu, Fernando11; Ritacco Lucas2; Ontivero, Paula3; Stipech, Guillermo4; Reyes, Joaquin5; Haeffelo, Ignacio6
1 Department of Otolaryngology, Sanatorio Guemes, Buenos Aires, Argentina;
2 Department of Computer-assisted Surgery, Hospital Italiano, Buenos Aires, Argentina;
3 Department of Otolaryngology, Sanatorio Guemes, Buenos Aires, Argentina;
4 Department of Otolaryngology, Godoy Cruz Clinic, Mendoza, Argentina;
5 Department of Otolaryngology, Univalle Hospital, Cochabamba, Bolivia;
6 Department of Otolaryngology, Iturraspe Hospital, Santa Fe, Argentina.

A printed 3D model is used in order to execute and practice the arpoach under virtual navigated. The planned trajectory was then executed in the patient. The objective’s work is to report a case of infracochlear endoscopic approach for the drainage of cholesterol granuloma of the petrosal apex with previous planning and virtual navigation on a 3D impression

A 43-year-old woman is referred by neurology for having a headache that does not resolve with multiple medications, loss of sensorineural hearing on the left side associated with tinnitus of 3 years of evolution. With the diagnosis of cholesterol granuloma, an endoscopic infracochlear approach was planned to aproach a transcanal tumor drainage assisted with intraoperative navigation. A plastic 3D model was printed

Planning was executed in a 3D model under virtual navigation. Surgery was simulated by drilling the 3D model. This experiment was carried on using surgical endoscope simulating the setting of the operating room These same steps were applied to the clinical case.

Both the simulation with the 3D impression, as well as the real intervention with the patient, were carried out without problems.

The tumor was drained without injury of important structures. The patient’s hearing was preserved and had to undergo surgery for residual tympanic perforation.

Although it wasnt possible to repeat the trajectory in a straight line to the target (proposed on the virtual navegation planing), we believe that this work may be first of many on planning, virtual navigation and EES. It is a major advantage for physicians to work with computer- aided surgery tools.