Objective: To investigate the concordance between optical images obtained with high-resolution microendoscopy (HRME) and conventional histopathology for ex vivo cholesteatoma specimens and surrounding middle ear epithelium.
Methods: After resection of cholesteatoma and surrounding middle ear epithelium from surgical patients, tissues were stained with a contrast agent, proflavine, and the HRME fiberoptic scope was placed directly on each tissue specimen. 4- 10 short movie clips were recorded for both the cholesteatoma and surrounding middle ear epithelium specimens. The imaged areas were sent for standard histopathology, and the stained specimens were correlated with the HRME images. IRB approval was obtained, and each patient was consented for the study.
Results: Ten cholesteatoma specimens and 9 middle ear specimens were collected from 10 patients. In each case,
cholesteatoma was easily discriminated from normal middle ear epithelium by its hyperfluorescence and loss of cellular
detail. Qualitative analysis for concordance between HRME images and histological images from the same surgical
specimen yielded a strong correlation between imaging modalities.
Conclusions: Keratinizing cholesteatoma and surrounding middle ear epithelium have distinct imaging characteristics. Loss of cellular detail and hyperfluorescence with proflavine are the hallmark characteristics of cholesteatoma which allow for differentiation from normal middle ear epithelium. Real-time optical imaging can potentially improve the results of otologic surgery by allowing for extirpation of cholesteatomas while eliminating residual disease. We anticipate performing an in vivo study to test this hypothesis.
In this paper, we proposed a new efficient implementation for simulation of surgery planning for congenital aural
atresia. We first applied a 2-level image segmentation schema to classify the inner ear structures. Based on it, several
3D texture volumes were generated and sent to graphical pipeline on a PC platform. By exploiting the texturingmapping
capability on the PC graphics/video board, a 3D image was created with high quality showing the accurate
spatial relationships of the complex surgical anatomy of congenitally atretic ears. Furthermore, we exploited the
graphics hardware-supported per-fragment function to perform the geometric clipping on 3D volume data to
interactively simulate the procedure of surgical operation. The result was very encouraging.
We have designed and implemented a prototype system to aid in the surgical repair of congenital aural atresia. A two- level segmentation algorithm was first developed to separate tissues of similar intensity or low tissue contrast. Then an interactive visualization modular was built to display the labeled tissues. The system allows a 3-stage interactive planning in which positioning, marking and drilling simulates the surgical operation of congenital atresia repair. A voxel-based volume CSG operation was implemented to ensure the efficiency of interactive planning. Six patients with congenital aural atresia underwent virtual planning in preparation for surgery. This technique has proved to be a valuable planning tool, with the potential for virtual representation of the surgical reconstruction.
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