Image Guided ESS
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Image guided endoscopic sinus surgery uses a preoperative CT scan and electromagnetic tracking to guide sinus surgery. Registration aligns the CT data with the patient's anatomy using fiducial markers. An electromagnetic tracker tracks the position of surgical instruments in real time. Calibration defines the position of instrument tips relative to the tracker. Accuracy ranges from 1-2mm. Image guidance is most useful for revision sinus surgery, surgery near the skull base, extensive polyps, and sinus tumors. Limitations include cost, time, and reliance on preoperative imaging. Future prospects include combining CT and MRI for anterior skull base surgeries.
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Image Guided ESS
- 1. IMAGE GUIDED ENDOSCOPIC SINUS SURGERY Dr. Surya
- 2. Sinus Surgery • Preoperative CT scan
- 5. Rationale • Allergic fungal sinusitis - significant erosion of the sinus cavity • Sphenoid sinus - more rapid identification of the face of the sphenoid and confirmation of entry into the sinus • Identification of the frontal recess • Diagnosing the roof of the ethmoid
- 6. Computer Aided Surgery • Computer-assisted surgery (CAS) represents a surgical concept and set of methods, that use computer technology for surgical planning, and for guiding or performing surgical interventions. • Other terms: – Computer-assisted intervention – Image-guided surgery – Surgical navigation
- 8. Registration • Registration is a process during which an IGS system calculates the one to-one relationships between corresponding points, termed fiducial points, in two locations – operating field volume (ie, the patient) – the imaging data set volume (ie, the CT or MRI scan).
- 9. Registration • Registration of the CT data-set volumes to the patient-set volumes was first performed by placing radiopaque fiducial markers on the patient before the CT scan • Glass beads, metal markers, plastic rods, skin staples
- 13. Calibration • Calibration is the process of defining (or confirming) the position of an instrument tip relative to a tracking device.
- 14. Calibration
- 15. Calibration
- 16. Accuracy • Accuracy in adults ranges from 1.4 mm to 2.0 mm • The accuracy of the system should be accessed visually on the face and against the middle turbinate. • If the system does not seem accurate, it should be promptly recalibrated
- 17. Indications • American Academy of Otolaryngology Head and Neck Surgery 1. Revision sinus surgery 2. Distorted sinus anatomy of development, postoperative, or traumatic origin 3. Extensive sino-nasal polyposis 4. Pathology involving the frontal, posterior ethmoid, and sphenoid sinuses 5. Disease abutting the skull base, orbit, optic nerve, or carotid artery 6. Cerebrospinal fluid rhinorrhea or conditions where there is a skull- base defect 7. Benign and malignant sino-nasal neoplasms 8. Choanal atresia
- 18. Patient Selection Localized disease Intermediate disease Advanced disease Image-guidance is not necessary Sinus disease is limited to the ethmoid and maxillary sinuses Image-guidance is helpful but not Necessary image-guidance is necessary Sinonasal fibrous dysplasia extends to the ethmoid roof or orbit Approaches to the skull base, pterygomaxillary fossa, infratemporal fossa
- 21. Limitations • Increased Cost • Increased Operative time • Accurate surgical navigation depends on robust registration. Bone-anchored fiducial markers provide the best accuracy. Impractical. • IGS technology does not change the nature of the surgical procedure. • All IGS platforms rely on preoperative imaging data sets.
- 22. Conclusion • Surgeons should always use their judgment with regard to surgery and trust their knowledge of anatomy rather than the computer system, which can give erroneous information. • Computer-assisted technology is best used in revision sinus surgery and sphenoid surgery.
- 23. Future Prospects • Combining CT and MRI – ENT and Neurosurgery for Anterior skull base approach to brain tumors
- 24. References: • Martin J. Citardi, Pete Batra. Image-Guided Sinus Surgery: Current Concepts and Technology (2005) • Ralph Metson, Stacey Gray. Image-Guided Sinus Surgery: Practical Considerations (2005) • James Palmer, David Kennedy. Historical Perspective on Image- Guided Sinus Surgery (2005) • Rodney Lusk. Computer-Assisted Functional Endoscopic Sinus Surgery in Children (2005) • Seth Brown, Arlen Meyers. Image-Guided Surgery (2018) • https://www.youtube.com/watch?v=SbpN4vFgQSY • https://www.youtube.com/watch?v=IOz484HGlVM • https://www.youtube.com/watch?v=zS3VUIewy5c
- 25. THANK YOU
Notas del editor
- video
- Sphenoid sinus is not frequently involved with chronic sinusitis. Only 10% to 15% ofpatients will require sphenoid surgery;
- Each point in each volume has a unique xyz coordinate; registration simply aligns corresponding xyz points. During surgical navigation, the IGS system can display the position of a probe in the operating field volume in the preoperative imaging data set volume by extrapolating from this mapping of corresponding points
- Paired-point registration
- Contour-based registration
- video
- The CT scan must be obtained with a standardized protocol appropriate for the computer-assisted hardware and software. The headframe may not fit well on the small heads of some children. There is a tendency to tighten the head frame to prevent it from sliding, butovertightening can cause pressure ulcerations over the forehead