gms | German Medical Science

Background: For few years navigation systems are used in the endoscopic sinus surgery (ESS). We were interested to find out whether this has repercussions on the surgical procedures.

Material & methods: Since December 2003 we evaluated prospectively all navigated ESS-procedures (Vector vision, Brain lab^®) by means of a form. Numerous data were determined (diagnosis, navigation use [analog scale], difficulty of the operation [analog scale], radiological score, complications etc.).

Results: Navigated ESS was carried out at 106 pat. (54♂; 52♀, average age: 55 y.) with the following diagnoses: 59×chronic sinusitis with nasal polyposis (13×primary surgery, 46×revision surgery), 14×mucocele, 10×malignant sinunasal tumour, 5×sinonasal inverted papilloma, 2×osteoma and 16×other diseases. There was only a slight correlation between difficulty of the operation and the use of navigation (r=0,51) and no correlation between the radiological score with chronic sinusitis and use of navigation (r=0,22). On the other hand we found a significant difference between the use of navigation between primary and revision FESS in cases of chronic sinusitis with nasal polyps (p=0,005). The benefit of navigation for the different diagnoses was from the largest to the smallest: recurrent polyposis, mucoceles, osteoma, malignant tumors, polyposis (primary surgery), inverted papilloma. Without navigation 15 operations (15%) would not have been possible as an endonasal procedure and 12 operations (12%) would not have been carried out thoroughly enough. In spite of navigation in 3 operations (4%) the endonasal approach had to be changed to a transfacial approach. 12 slight and 3 heavy complications (1×dura defect + pneumoencephalon, 1×dura defect, 1×meningitis without CSF leak) occured.

Conclusions: In the meantime navigation exerts influence on the execution of the ESS, by extending their possibilities clearly.