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S U R G I C A L
N A V I G A T I O N
instruments, which transmit images to the system's transmitter.
This technology has improved dramatically in recent years. Earlier systems
experienced lag time between where an instrument was actually located and
where it would show up on the screen. Now the movements are fluid and very
close to real time. The newer systems also let surgeons register almost all of
their own instruments instead of relying on a single registered pointer to track
their progress.
Plenty of applications
Image-guided surgery is not the standard of care, but it has widespread application. Almost all training programs use it, and most private practice surgeons are
becoming well-versed in the technology. Its use is becoming widespread in the
ENT field.
One common indication for the technology is revision sinus surgery, because
the normal anatomy has been altered. I might not use image guidance for revision surgery if I did the primary procedure, but will certainly rely on the technology any time I'm following up on another surgeon's work. I'll also use it for
patients who present with abnormal sinus anatomy related to developmental,
traumatic or post-operative issues.
Additionally, the American Academy of Otolaryngology – Head and Neck
Surgery endorses use of the technology for extensive sino-nasal polyposis; pathology involving the frontal, posterior ethmoid and sphenoid sinuses; disease abutting
the skull base, orbit, optic nerve or carotid artery; cerebrospinal fluid or conditions
involving a skull-base defect; and benign and malignant sino-nasal neoplasms.
Traditionally, image-guided ENT works off MRI or CT scan images. Newer systems, however, can fuse the images, which is extremely useful when removing
tumors from the skull base.
Differentiating between tumor and sinus disease is difficult on a CT scan, but
bone structure is clearly defined. On the other hand, an MRI will clearly show a
tumor, but won't display bone structure. Combining the images lets surgeons identify the tumor via the MRI and the bone structure via the CT scan.
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