HOW I DO IT: The Frontal Bone Skull Post for Image Guided Surgery of the Nasopharynx

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Background and Objectives:To describe the use of the mastoid skull post of a surgical image guidance system for image guided surgery and intraoperative navigation of the nasopharynx. This adaptation overcomes the limitations of a headset frame or head clamp and can be applied to open and closed surgery of the nasal cavities, sinuses, orbits, midface and anterior skull base.Methods:A sterile mastoid skull post of a surgical image guidance system was securely screwed into the outer table of the frontal bone and a passive reference frame fixed to it. The position of the reference frame relative to the patient's head remained constant during surgery.Results:Between August 2002 and November 2006, 22 patients underwent a surgical nasopharyngectomy using an image guidance system and frontal bone skull post. No surgical complications or complications of the frontal bone skull post occurred.Conclusion:Using the skull post of a surgical image guidance system anchored to the frontal bone to carry a passive reference frame provides real-time visual information about the relationship of relevant anatomy to the surgical field on a fully mobile head in open or closed procedures of the midface and anterior skull base while accuracy and sterility are maintained.

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