Article
Image-Guided Sinus Surgery: Current Concepts and Technology
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Authors
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Martin J. Citardi
- Cleveland Clinic Found, Head & Neck Institute, Section of Nasal & Sinus Disorder, A 71 Cleveland/Ohio, USA
| Published: | April 24, 2006 |
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Outline
Text
The domain of computer-aided surgery (CAS) encompasses a wide range of semiconductor-based technologies. Intraoperative surgical navigation (also known as image-guided surgery, or IGS), which provides a means for the correlation of preoperative imaging with intraoperative anatomy, is the most widely recognized CAS application in rhinology.
Registration is the process of mapping corresponding coordinates in the image space (namely the preoperative imaging data set) and the surgical volume (or the operative field). Thus registration supports all aspects of surgical navigation. Registration protocols may be classified as paired-point registration, automatic (or headset-based) registration and contour-based registration. Principles from registration error theory may be applied clinically to reduce errors associated with poor registration. Although registration concepts are complex, a functional understanding of them helps elucidate critical limitations that are intrinsic to surgical navigation.
Clinical experiences have shown that IGS is helpful in certain anatomic regions (frontal sinus, posterior ethmoid and sphenoid) and in specific clinical situations (revision surgery, sinonasal polyposis, allergic fungal rhinosinusitis, etc.). In addition, IGS is helpful for the so-called advanced endoscopic techniques, including CSF leak repair and resection of sinonasal neoplasms.
Recent advances in IGS technology include the incorporation of 3D CT angiography (3DCTA), which provides important information about the internal carotid artery and its relationships to critical structures. Furthermore, CT and MR scans may be “fused” to provide hybrid images for intraoperative navigation. Such images have wide applications for the management of skull base lesions.
In sum, the IGS paradigm represents an important advance for contemporary rhinology, since it may help facilitate endoscopic management of complex paranasal sinus and skull base pathology. The technology that supports IGS is advancing, and thus, the importance of IGS for surgical rhinology is likely to grow and evolve as new strategies are developed and applied.
