Considerations of Stereotactic Guidance in Sinus Strategy

Session Description

There has been a dramatic evolution in computer assisted surgical navigation, since our early work with servo-arms and limited accuracy electromagnetic and line of sight optical systems.  Computer assisted imaging has become significantly more surgeon friendly, less intrusive into the operative field and enables improved pre-operative planning, virtual navigation and ‘painting’ of areas and tumors removed during surgery.  Most importantly however, the triplanar views provide the surgeon with the ability to carefully conceptualize the anatomic variations and disease which will be encountered intraoperatively and to devise an individualized surgical plan prior to surgery.  However, despite these advances, intraoperative accuracy and ease of registration remain the most important system elements.  Intraoperative accuracy has been aided by improvements in registration and by distal tip instrument sensors.  In particular, the latter has enabled fine malleable probes which allow for atraumatic identification of the frontal sinus pathway, and the sphenoid ostium, as well as for balloon navigation.  Despite these advances, although intraoperative surgical navigation improves surgeon confidence, there is little evidence that it reduces complications.  Until there is consistent sub-millimeter accuracy, it is not the mainstay of a surgical procedure and remains very much secondary to anatomic landmarks from direct visualization.