DOI: 10.1097/SCS.0b013e318191d091
,
Issn Print: 1049-2275
Publication Date: 2009/01/01
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Excerpt
J.N. Palmer, MD
A.G. Chiu, MD
D.W. Kennedy, MD
Am J Rhinol 2008;22(2):170-174.
Image-guided functional endoscopic sinus surgery (ESS) based on preoperative computed tomographic (CT) images for navigation facilitates complex endoscopic sinus procedures and decreases the need for revision. Although helpful, the present system does not provide the intraoperative anatomic changes that occur during surgical manipulation. This challenge may be met with utilization of improved intraoperative imaging, and in the present study, Jackman et al evaluated the effect of intraoperative CT scanning during ESS. Not only did the study authors assess the technical feasibility of intraoperative CT scanning, but the potential impact of intraoperative CT scanning in conjunction with real-time update of computer-assisted navigation during ESS was evaluated as well.
Intraoperative CT scanning was performed in 20 select patients undergoing functional ESS. The use of a portable, highly maneuverable CT scanner, the xCAT ENT by Xoran Technologies, allowed acquisition of real-time, intraoperative images in ESS. Before procedure conclusion, scans were evaluated for residual disease or cellular partitions. These intraoperative CT images were successfully obtained in 40 seconds on average, and loading onto an image guidance system required only minutes. Information obtained from the intraoperative CT scan led to alteration in the surgical plan in 30% of patients, and no complications were linked to CT scan use.
In the present study, Jackman et al successfully showed that intraoperative CT scanning can be performed with currently available technology and has the potential to improve the extent of surgery in patients with complicated anatomy and extensive disease.
In this series, intraoperative imaging showed residual anatomic disease, warranting additional surgery in one third of cases. Considering the significant impact intraoperative CT scanning demonstrated on the current cohort, it seems clear that this technology can provide the sinus surgeon with updated information and increase the completeness of surgery. Its use in functional ESS warrants much further study.
