Endoscopic Sinus Surgery Using Intraoperative Computed Tomography Imaging for Updating a Three‐Dimensional Navigation System

Abstract

Objectives: The use of three-dimensional navigation systems provides information on the structures surrounding the field of operation and thereby reduces the risk of iatrogenic damage. The computed tomography (CT) data conventionally used are provided by preoperative scanning procedures, which means that tissue changes coming about during surgery are not seen on the screen. An intraoperative CT scanning procedure being able to update the CT data could provide a solution. Study Design: Endoscopic s inus operations using an intraoperative CT updating the three-dimensional navigation system were performed on six persons to find out, whether the above is true. Methods: Different parameters, advantages, and disadvantages in the cases of these six patients were compared with a group of 22 patients who underwent conventional endoscopic sinus surgery with different three-dimensional navigation systems without updating the CT data set. Results: The intraoperative CT for updating the three-dimensional navigation system provides useful information for the surgeon. Conclusion: Balancing its advantages against its disadvantages, the updating of the CT data set with intraoperative CT cannot be recommended for conventional standard endoscopic s inus surgery.

Accuracy of surface registration in cranial electromagnetic navigation

“…This means that addition of landmarks to surface registration did not improve accuracy of surgical navigation. Overall, the TRE values observed in this study were within the range reported in other studies of electromagnetic registration [13,15,[21][22][23][24]. We were also interested, how accuracy of surface registration compares to the reference registration mode using bone anchored fiducials applied before the preoperative CT scan.…”

Three‐dimensional tomosynthesis and cone‐beam computed tomography: An experimental study for fast, low‐dose intraoperative imaging technology for guidance of sinus and skull base surgery

“…Cartellieri et al stated that the system provides the surgeon with higher precision of the threedimensional navigation systems, recognition of intraoperative tissue changes, and an improved feeling of assurance. 5 On the other hand, the patients are repeatedly exposed to radiation and prolonged anesthesia. In addition, both technical and personnel resources are higher with the associated added cost burden.…”

Image guided surgery of the lateral skull base: Testing a new dental splint registration device

“…The high accuracy and reliability of this novel registration device was proven by the measurement of values in the submillimetric range for target fiducials located in the lateral skull base region, which almost matched the accuracy of fixed bone-implanted marker registration. Although the more distant targets yielded slightly larger values, confirming the significant impact of the distance between the registration and target points on the accuracy [7,8,21], even the maximum deviation of 1.2 mm is still within the range (1 to 2 mm) that is often considered ''clinically acceptable'' for navigation system accuracy [1,21,25,26]. Maxillary splint-based systems with extraoral extensions for reference markers have been used previously with sufficient navigational accuracy in neurosurgery (0.29-0.86 mm [17], 0.0-2.0 mm [27]), in sinus surgery (1.56 AE 0.76 mm [28]), and in the temporal region (0.73 AE 0.25 mm [17,29]); however, only a few of these systems have been tested for targets in the lateral skull base region [15,29,30,31].…”

“…They are widely accepted as useful tools for intraoperatively identifying important anatomical structures and assisting in the exact positioning of surgical instruments, especially when conditions are complex because of the loss of surgical landmarks as a result of previous surgeries or tumor destruction [1][2][3].…”