Image‐Guided Surgery Influences Perioperative Morbidity from Endoscopic Sinus Surgery: A Systematic Review and Meta‐Analysis

Abstract

Objective. Although image-guided surgery (IGS) is considered a valuable tool, its impact on perioperative morbidity for endoscopic sinus surgery (ESS) remains unclear. The evidence from reported literature is systematically reviewed with meta-analysis.Data Sources. MEDLINE (1946 to September 14, 2012 and EMBASE (1974 to September 14, 2012.Review Methods. MEDLINE and EMBASE were searched using a search strategy for publications on IGS during ESS that reported original data on perioperative morbidity. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were followed. Both comparative cohort studies with non-IGS cases and case series were included. Primary outcome was major and total complications. Secondary outcomes were specific orbital and intracranial injury, major hemorrhage, ability to complete the operation, and revision surgery. The incidence of these events was defined as dichotomous variables and expressed as a risk ratio (RR) in a fixed-effects model.Results. In total, 2586 articles fulfilled the search, producing 55 included studies. Fourteen were comparative cohorts of IGS and non-IGS sinus surgical patient populations used for meta-analysis. Among the cohorts, major complications were more common in the non-IGS group (RR = 0.48; 95% confidence interval [CI], 0.28-0.82; P = .007). Total complications were greater in the non-IGS group (RR = 0.66; 95% CI, 0.47-0.94; P = .02). All other outcomes did not reach significance on meta-analysis.Conclusion. Contrary to current review articles on the topic of IGS use during ESS, there is evidence from published studies that the use of IGS for sinus surgery, within selected populations, is associated with a lower risk of major and total complications compared with non-IGS sinus surgery. Although IGS is considered a valuable tool, its impact on perioperative morbidity and patient-reported outcome measures (PROMs) for ESS remains unclear. Current evidence based on a small number of individual cohort studies and case series has not consistently demonstrated a significant advantage of IGS over non-IGS ESS. Given the low incidence of complications, a large sample size in both the IGS and non-IGS study group arms is required. Several evidencebased reviews have recently evaluated the impact of IGS during ESS on complications and clinical outcomes. 3,4 However, while these studies attempt to be systematic, they provide a qualitative and opinion-based recommendation for the indications of IGS for ESS. This meta-analysis is performed using pooled data from published studies to address the impact of IGS on perioperative morbidity and PROMs. MethodsA systematic review of the published literature was undertaken to collate studies providing original data on the patient outcomes following IGS-based sinus surgery. A metaanalysis was performed on the studies that were randomized controlled trials, retrospective cohorts, or prospective cohorts that had a control population. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-...

Postoperative Correlation of Radiological and Surgical Findings in Management of Ethmoid Sinus Adenocarcinoma

“…It is hard to say whether more frequent use of this tool had reduced our recurrence rates. In fact, Dalgorf et al, in a recent metaanalysis [18], were unable to demonstrate a statistically signifi cant benefi t for the use of imaging-guided surgery on the need for surgical revision (RR = 0.72) while this use is associated with a reduction in the rate of complications. It was also the same in the study of Ramakrishnan et al [19].…”

Endocranial Complications of Endoscopic Sinus Surgery: Learning from Experience

“…To prevent anatomical damage, surgeons must be mindful of the anatomical areas most at risk of penetration into the cerebral cavity, such as the cribriform plate, the ethmoid fovea, the roof of the ethmoidal cells and the lateral walls of the sphenoid sinus [5]. Knowledge of patient anatomy and training for performance of meticulous surgical techniques are very important for avoiding complications [3] [13] [14].…”

“…A CSF leak is the most frequent endocranial complication [5]. A CSF leak is the communication between the subarachnoid space and the nasal mucosa caused by destruction of the boney plane that separates these spaces.…”

“…Although FESS is considered safe when performed by experienced surgeons [5] [6], complications continue to be reported despite technical and instrumental advances [1] [7]- [9]. These complications are divided into major and minor categories [1] [8] [10]: intra/postoperative and immediate/delayed [1] [5] [8] [10].…”

“…These complications are divided into major and minor categories [1] [8] [10]: intra/postoperative and immediate/delayed [1] [5] [8] [10]. Major injuries and life-threatening endocranial complications include [1] involuntary penetration into the skull base, production of a cerebrospinal fluid (CSF) leak, meningitis, pneumocephalus and epidural or intracerebral abscess [1] [3] [5] [8] [9]. Knowledge of the mechanism of injury is essential for prevention, identification and immediate correction of these complications [2] [3] [5] [7].…”