Применение интраоперационной навигации в эндоскопической хирургии доброкачественных костно-фиброзных образований околоносовых пазух и основания черепа

Abstract

Objective. Evaluation of the effectiveness and safety of the use of electromagnetic computer navigation in endoscopic surgery of benign fibro-osseous mass of the paranasal sinuses and skull base. Materials and methods. The retrospective study included 21 patients who underwent endoscopic removal of fibro-osseous mass of paranasal sinuses and skull base at the Burdenko Center from 2010 to 2021. The patients were divided into 2 groups: the 1st group included 10 patients with the use of electromagnetic navigation intraoperatively, the 2nd group included 11 patients who were treated without the use of navigation. Median follow-up was 24 months [IQR 12,00, 48,00]. Results. Most often, patients complained of headache (15; 71,4%). In 14 (66,7%) cases, the ethmoid labyrinth was involved; in 11 (52,3%) cases, the sphenoid sinus; in 15 (71,4%) cases, the base of the skull, with intracranial distribution in 5 (23,8%) cases; and in 8 (38%) cases, the wall of the orbit. Surgical treatment was performed radically in 10 (47,6%) patients. The median intraoperative blood loss was 100.00 mL. Intraoperative complications occurred in 3 (14,3%) patients; postoperative complications, in 2 (9,5%) patients. Pathology recurrence occurred in 4 (19,0%) patients, more often in young people (median age 19,50, р = 0,179). The median duration of hospital stay was 3,00 bed-days. It was found that the localization of pathology in the sphenoid sinus is associated with an increased risk of nonradical removal of the formation (р = 0.009). Factors that could influence the choice of the surgeon in favor of intraoperative navigation include visual impairment in the clinical picture of the disease (p = 0,090) or the absence of difficulty in nasal breathing (p = 0.024); localization of the mass only in the sphenoid sinus (p = 0,063) or with involvement of the base of the skull (p = 0.149). The use of intraoperative navigation slightly increases the radicalness of surgical treatment and reduces the incidence of perioperative complications.