Navigational systems in rhinology: should we all be using them?

[Transnasal endoscopic surgery of neoplasms in the children with the use of the CT-navigation systems]

The objective of the present article was to report the current literature data concerning the significance of and prospects for the application of the CT-navigation systems in transnasal endoscopic surgery of neoplasms localized in the nasal cavity, nasopharynx, paranasal sinuses, and the base of the skull in the children.

Anatomical variations of the sphenoid sinus and its adjacent structures: a review of existing literature

The sphenoid sinus, one of the posterior groups of sinuses, has long been regarded as a 'neglected sinus' due to the anatomical location, poor understanding and poor accessibility, till the advent of endoscopes and modern imaging techniques. Increasing knowledge and greater understanding of this sinus has permitted an evolution in surgical practices and boundaries. Various literatures of the past report a great variety of rates of pneumatization, rates of optic nerve protrusion and dehiscence, as well as internal carotid artery (ICA) protrusion and dehiscence. One similarity noted among these studies is that the rates vary according to the ethnicity of the patients. Recommendations have also been made along the way with regard to modified surgical techniques. This review aims to describe the pneumatization of sphenoid sinus and the topographical relation of the optic nerve and ICA in different populations.

Image-guided sinus surgery: practical and financial experiences from a UK centre 2001-2009

BACKGROUND

Image guidance surgery is an emerging technology that may allow more efficient treatment of sinus disease. This retrospective study examines National Health Service and military patients who underwent procedures using image guidance surgery during the period 2001-2009.

METHODS

Medical records were reviewed in terms of indications for surgery, incidence of major complications and need for revision following image guidance surgery. An attempt was also made to determine the cost-effectiveness of purchasing this navigational system.

RESULTS

A total of 132 patients underwent 147 procedures using image guidance surgery over the 8-year period. The indications for surgery ranged from severe nasal polyposis and chronic rhinosinusitis to malignant tumours in the paranasal sinus and skull base region. Average length of follow up was 17.6 months. Four patients had a major complication. Fourteen patients underwent revision surgery. The cost of providing an image guidance surgery service was estimated to be £110,000-120,000 during the study period. The economic model for the subgroup of nineteen military patients (with non-polypoid chronic rhinosinusitis) suggests that use of this technology will reduce overall costs by approximately £70,000 when compared with conventional sinus surgery.

CONCLUSION

This study provides some evidence that image-guided sinus surgery is cost effective, safe and may decrease surgical revision rates.

Automated detection of fiducial screws from CT/DVT volume data for image-guided ENT surgery

This paper presents an automated solution for precise detection of fiducial screws from three-dimensional (3D) Computerized Tomography (CT)/Digital Volume Tomography (DVT) data for image-guided ENT surgery. Unlike previously published solutions, we regard the detection of the fiducial screws from the CT/DVT volume data as a pose estimation problem. We thus developed a model-based solution. Starting from a user-supplied initialization, our solution detects the fiducial screws by iteratively matching a computer aided design (CAD) model of the fiducial screw to features extracted from the CT/DVT data. We validated our solution on one conventional CT dataset and on five DVT volume datasets, resulting in a total detection of 24 fiducial screws. Our experimental results indicate that the proposed solution achieves much higher reproducibility and precision than the manual detection. Further comparison shows that the proposed solution produces better results on the DVT dataset than on the conventional CT dataset.

Development of an auditory implant manipulator for minimally invasive surgical insertion of implantable hearing devices

Objective:

To present the auditory implant manipulator, a navigation-controlled mechanical and electronic system which enables minimally invasive (‘keyhole’) transmastoid access to the tympanic cavity.

Materials and methods:

The auditory implant manipulator is a miniaturised robotic system with five axes of movement and an integrated drill. It can be mounted on the operating table. We evaluated the surgical work field provided by the system, and the work sequence involved, using an anatomical whole head specimen.

Results:

The work field provided by the auditory implant manipulator is considerably greater than required for conventional mastoidectomy. The work sequence for a keyhole procedure included pre-operative planning, arrangement of equipment, the procedure itself and post-operative analysis.

Conclusion:

Although system improvements are necessary, our preliminary results indicate that the auditory implant manipulator has the potential to perform keyhole insertion of implantable hearing devices.