Quantification Of The Interventional Approaches Into The Pterygopalatine Fossa By Solid Angles Using Virtual Reality

Virtual reality is increasingly used in medicine for diagnostics, for visualisation of complex structures and for preoperative planning. In interventional radiology, minimally invasive approach could be described with a target point representing the desired needle tip position and an array of all possible trajectories leading to it resembling irregular "cone" or "pyramid". We present a pilot study of planning a minimally invasive posterior infrazygomatic and suprazygomatic approaches into the pterygopalatine fossa using a solid angle as a measure of size of the approach in five virtually reconstructed heads. The minimally invasive approaches were planned by manually drawing the edges of "pyramids" that described each approach in 3D using virtual reality program Tracer. For each head, a transverse diameter was measured and for each approach a solid angle size, average edge length and estimated area on the skin from where the target point could be reached were calculated. We found that, the solid angle of posterior infrazygomatic approach was significantly larger than suprazygomatic approach (p<0.001). Furthermore, the transverse head diameter and solid angle in posterior infrazygomatic approach were negatively correlated (rho=-0.55, p=0.0002), while transverse head diameter and the estimated area on the skin from where the target point could be reached in the suprazygomatic approach were positively correlated (rho=0.37, p=0.0206). In conclusion, our findings provide important preliminary evidence on the feasibility of evaluating and comparing different minimally invasive approaches using virtual reality systems, and affirm the validity of solid angle as a measure of the size of the approach.