Use of image-guidance navigation system in nasal endoscopic surgery

Abstract

Objective To summarize the experiences of the use with image-guidance navigation system in endoscopic nasal surgery. Methods Thirty-three cases (navigation group) undergoing endoscopic nasal surgery with image- guidance navigation system (Stealth Station Lanmar X, Medtronics) were reviewed, including 21 cases of chronic rhinosinusitis with or without nasal polyps, 4 of isolated sphenoid sinus, 3 of frontal sinusitis, 2 of nasal inverted papilloma, 1 of maxillary sinus osteoma, and each 1 of osteofibrous dysplasia of the frontal sinus and the sphenoid sinus. Depending on the head fixation device during procedure, the 33 patients were allocated to group A (n=15) using Mayfield 3-pin head clamp and group B (n=18) using noninvasive head frame. A contemporary cohort receiving traditional endoscopic sinus surgery were recruited as control group(n=43), including 30 cases of chronic rhinosinusitis with or without nasal polyps, 4 of isolated sphenoid sinus, 6 of frontal sinusitis, and 3 of nasal inverted papilloma. The precision of image-guidance navigation was evaluated. Moreover, the preparation (image registration) time of A and B groups, operation time, estimated blood loss and postoperative complications of navigation and control groups were compared. Results Anatomical landmarks were well localized by image- guidance navigation system. Group A required longer image registration and preparation time as compared with group B [(50.67±19.26) min vs (21.67±12.90) min, P＜0.05]. There were no significant differences in operation time[(61.67±18.53) min vs (63.84±16.93) min, P＞0.05]and blood loss[(123.18±53.31) ml vs (127.79±63.59) ml, P＞0.05]between navigation group and the control group. For treatment of sphenoid sinusitis,frontal sinusitis and nasal neoplasms, navigation-guided surgery required remarkably shorter operation time than the traditional option[(55.00±23.55) min vs (70.38±18.45) min, P＜0.05]. Postoperative bleeding and other serious complications were not seen in both groups. Conclusion Nasal endoscopy in combination with image-guidance systems provides accurate anatomical localization of nasal cavity, sinuses and anterior skull base. Key words: Surgery, computer-assisted; Endoscopy; Otorhinolaryngologic surgical procedures; Stereotaxic techniques; Treatment outcome