Template-based registration for image-guided skull base surgery

Objectives: To evaluate whether patient-to-image registration with the use of a maxillary template is sufficiently accurate for image guided skull base surgery. Study Design and Setting: In an experimental phantom study, pair-point registration of a skull phantom to its CT image data was performed with 243 different configurations of a maxillary template with markers. Then artificial skull mounted target markers were located with an infrared tracking device as used in navigation systems. Results: The average target registration error was 1.57 mm in the anterior skull base (95% confidence interval, 1.53 to 1.61 mm), but 3.31 mm in the lateral skull base (95% confidence interval, 3.26 to 3.37 mm). Conclusions: Fiducial marker registration based on a maxillary template is sufficiently accurate for image-guided surgery in the anterior skull base. but not for the lateral skull base. Significance: Template-based registration is an accurate yet noninvasive registration method for frontal skull base surgery. (C) 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.