Image-Guided Sinus Surgery

Abstract

Image-guided sinus surgery (IGSS) is a type of computer-assisted surgical navigation technique. It is also termed computer-aided surgery (CAS) as well as computer-assisted navigation (CAN). Compared to its first description in the 1990s, it is now widely applied by the rhinologists worldwide. While it is not a substitute for surgical expertise or a thorough anatomical knowledge for endoscopic sinus surgery (ESS), it is a valuable aid during any challenging ESS procedure, including surgery for chronic rhinosinusitis, benign sinonasal tumors, CSF rhinorrhea, etc. IGSS is especially helpful in cases of revision ESS, frontal or sphenoid sinus surgery, and ethmoid surgery approaching the ethmoid roof. However, there are also disadvantages including increased cost and increased time in the operating room, particularly early on in the user’s experience as they learn the nuances of system registration. A typical system localizes the tip of a probe, suction, or instrument in three different planes on the patient’s preoperative computed tomographic (CT) images viewed on an attached monitor, while a fourth panel on the screen will frequently contain an endoscopic view. The tip of the instrument is depicted by crosshairs on the abovementioned orthogonal images. Accuracy of the tip localization on the CT images is recognized to be 2 mm or better, thereby providing the surgeon with greater confidence when working in more vulnerable areas such as frontal sinus, optic nerve, base of skull, etc. during ESS. In this chapter, we aim to provide the reader with an understanding of the technology and technique of IGSS and its clinical use in standard and complex cases of ESS.