Der Einfluss der Navigation auf die endoskopische NNH-Chirurgie

Abstract

Over the last few years, navigation systems have been used in endoscopic sinus surgery (ESS). We were interested determining whether this has repercussions on surgical procedures. From December 2003 to April 2006, we prospectively evaluated all navigated ESS procedures (Vector vision, Brain lab) by means of a questionnaire. Numerous data were determined including diagnosis, navigation benefit, difficulty of the operation, radiological score and complications. Navigated ESS was carried out on 106 patients (54 male symbol; 52 female symbol, average age 55 years) with the following diagnoses: 59 chronic sinusitis with nasal polyposis (13 primary surgery, 46 revision surgery), 14 mucocele, 8 benign tumour, 10 malignant sinonasal tumour, and 15 other diseases. There was only a slight correlation between the difficulty of the operation and the use of navigation (r=0.51, P=0.00) and no significant correlation between the radiological score with chronic sinusitis and the use of navigation (r=0.22, P=1.23). On the other hand, we found a significant difference between the benefit of navigation using primary and revision functional ESS in cases of chronic sinusitis with nasal polyps (P=0.005). The degree of benefit of navigation for the different diagnoses was in descending order: recurrent polyposis, mucocele, osteoma, malignant tumors, polyposis (primary surgery) and inverted papilloma. Without navigation, 15 operations (14%) would not have been possible as an endonasal procedure, and 12 operations (11%) would not have been carried out thoroughly enough. In spite of navigation in three operations (3%) the endonasal approach had to be changed to a transfacial approach. Twelve slight and three serious complications (1 dura defect + pneumoencephalos, dura defect, meningitis without CSF leak) occurred. Navigation exerts a substantial influence on the execution of the ESS by clearly extending its possibilities.