Multi-Port bone surgery using the example of the temporal bone

DFG-Forschergruppe FOR 1585

The DFG research project "Multi-Port bone surgery using the example of the temporal bone" (MUKNO) is a cooperation between the ORL-clinic in Düsseldorf, the "WZL" of the RWTH Aachen and the "Interactive Graphics System Group" of the TU Darmstadt. The aim of the project is to investigate how minimally traumatic surgical procedures at the otobasis can be accomplished. The main challenge here is not to damage any important structures such as the facial nerve or the carotid artery. So far, the surgeon dissects all collision structures in the surgical field which means a high risk for the patient. In future, only three drilling canals should be used. Through these canals the instruments are inserted and the computer supports the surgeon during the navigation. In order to keep the complication rate under 0.5 %, the process chain has to be controllable. This means in every step of the chain - from the image acquisition over the segmentation, registration and planning to the drilling - the possible error should be kept under a feasible threshold.

Particular projects of MUKNO


Image acquisition

In order to keep the complication rate under 0.5%, the generated three dimensional images should have an isotropic resolution of 0.1-0.2 mm. To achieve this aim two approaches are studied:

- Image acquisition using Cone Beam CT which has high special resolution with isotropic voxel size.

- Providing of two orthogonal sets of image volumes by means of conventional CT. These highly anistropic data sets can be then processed using a super-resolution reconstruction algorithm to reconstruct an isotropic volume data while increasing the image quality.

Contact: Wissam El Hakimi



In order to be able to further process the acquired images, the structures have to be segmented. Often the important structures like facial nerve and carotid artery are difficult to distinguish in the images. Therfore, we integrate a-priori knowledge in the segmentation. Here, it is also important to quantify the accuracy of the segmentation.

Extract of the temporal bone, where the facial nerve has been segmented manually.

Contact: Meike Becker



The position of the instrument relative to the patient’s anatomy should be controlled during the operation. For this purpose appropriate verification images are to be acquired. After registration of the intra- and proxy-operative image data the actual instrument position can be determinated and in case of error corrected. The main challenge here is to develop a “real time” capable registration method.

Contact: Wissam El Hakimi



We developed a tool which analyses - based on pre-operatively acquired CT data - if it is at all possible to reach the target of the intervention using linear drill canals without damaging any important anatomical structures. Here, we first compute all feasible paths, i. e. all paths which do not damage any critical structure. From this set, the surgeon can then manually choose a combination of three paths.

Path combination chosen by a clinician for the surgical target of the petrous apex.

We use the SOFA-Framework (SOFA) as a basis for our simulation software.

Contact: Meike Becker


  • Variance-based iterative image reconstruction from few views in limited-angle C-arm computed tomography
    El Hakimi, Wissam; Sakas, Georgios
    In: SPIE Medical Imaging Symposium 2014, San Diego, CA, USA, 2014
  • Path Planning for Multi-port Lateral Skull Base Surgery Based on First Clinical Experiences
    Meike Becker, Stefan Hansen, Stefan Wesarg, Georgios Sakas
    In: Clinical Image-Based Procedures. Translational Research in Medical Imaging, Volume 8361, Springer International Publishing, 2014>
  • Accurate Super-Resolution Reconstruction for CT and MR Images
    El Hakimi, Wissam; Wesarg, Stefan
    In: IEEE Symposium on Computer-Based Medical Systems (CBMS) 26, Porto, Portugal, 2013
  • Anisotropy Correction of Medical Image Data Employing Patch Similarity
    Keyhani, Mohammad Hossein; El Hakimi, Wissam; Wesarg, Stefan
    In: IEEE Symposium on Computer-Based Medical Systems (CBMS) 6, Porto, Portugal, 2013
  • Towards Automatic Path Planning for Multi-port Minimally-Traumatic Lateral Skull Base Surgery
    Meike BeckerAffiliated withCarnegie Mellon UniversityInteractive Graphics Systems Group, TU Darmstadt, Ralf Gutbell, Igor Stenin, Stefan Wesarg
    In: Clinical Image-Based Procedures. From Planning to Intervention, Volume 7761, Springer Berlin Heidelberg, 2013
  • Ein Prototyp zur Planung von Bohrpfaden für die minimal-invasive Chirurgie an der Otobasis
    Ralf Gutbell, Meike Becker, Stefan Wesarg
    In: Bildverarbeitung für die Medizin 2012, Springer Berlin Heidelberg, 2012
  • Confidence map based super-resolution reconstruction
    El Hakimi, Wissam; Wesarg, Stefan
    In: SPIE Medical Imaging Symposium 2012, San Diego, CA, USA, 2012
  • Planning of High Precision Surgery at the Lateral Skull Base
    Wesarg, Stefan; Becker, Meike; El Hakimi, Wissam
    In: Korea-Germany Joint Workshop on Advanced Medical Image Processing 14, Heidelberg, Germany, 2011



Technische Universität Darmstadt

Interactive Graphics Systems Group

Fraunhoferstr. 5
64283 Darmstadt

Tel. +49 6151 155 679

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