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sedated in the OR, they'd avoid having to order new scans (and the
associated costs), could remove residual pathology cells immediately or
set a plan for doing so in the future. Until MRI and C-arm designs
become more compact or image-capture technology evolves altogether,
real-time image capture during sinus surgery is not yet ready for prime
time.
Surgeons currently maneuver laterally through the ear to get to the
central part of the brain stem and skull base, because the anatomy is
familiar. Researchers are exploring the potential of using image-
guided technology to work through the sinuses to safely perform
extensive surgeries in previously unreachable areas of the skull
base. For example, brain aneurysms are currently treated endovas-
cularly or with a craniotomy. Surgeons approach through an artery
to place a coil in the weakened vessel wall or remove a portion of
the skull to locate and clip the vessel. Image guidance might allow
for passage through the sinuses, a potentially safer and more effec-
tive route. It would require removing a lot of bone, but it's an excit-
ing potential application of the technology. OSM
Dr. Donovan (
ddonovan@houstonmethodist.org
) is an ENT-otolaryngolo-
gist at Houston Methodist Hospital in Houston, Texas.
S I N U S S U R G E R Y
