Chronic Sinusitis

Andrew Biello

Content Contributor

Evolution of Technology

Surgical Navigation Systems

Surgical navigation systems are popular tools during sinus and skull base surgery, which allow the surgeon to upload CT scans of individual patients into a computer. The scans are then synchronized with the surgical instruments, so that the exact location of the surgical instrument can be visualized in relation to its whereabouts on the patients 3D CT scan rendering. This allows the surgeon to localize key structures, and validate spatial anatomy that is seen endoscopically. Image guidance systems are a valuable tool in preventing injury to these key structures.

Evolution of Procedure

Functional Endoscopic Sinus Surgery

FESS is aimed at mucosal preservation, while also removing obstructions in sinus anatomy, with the main goal being restoration of normal sinus anatomy and physiology. Endoscopy for sinus surgery was first described in the early 1900s. The improvement of rod-optic systems in the 1970s provided a drastic improvement in visualization. In the 1990s, image guided navigation gained popularity in the USA. It became a means to confirm anatomic location intra operatively using a specific patients imaging in order to achieve maximal reduction of disease. This method also allowed for the identification and confirmation of critical structures that should be avoided during surgery.

Evolution of Diagnosis

Chronic Sinusitis

Chronic rhinosinusitis is an inflammatory disorder of the paranasal sinuses, defined as lasting 12 weeks or longer. It is commonly diagnosed in middle-aged individuals, and may present with purulent drainage from the nose, nasal obstruction, headache, facial pressure or pain, and/or decreased sense of smell.

Severe untreated cases can lead to meningitis, high fevers, vision problems, proptosis, cranial nerve deficits, or nosebleeds. A CT of the sinuses is typically performed to evaluate extent of disease, and for surgical planning. Typically, sinus disease is initially managed with intranasal steroids and saline rinses. When sinus disease persists despite these measures, surgery is typically pursued.

Technology Spotlight

Medtronic StealthStation Surgical Navigation System

The StealthStation surgical navigation system allows you to see your instrument tip on the screen, which allows a safer and more thorough resection, and can decrease the chances of violating important anatomic structures. Knowledge of precise surgical location is important during skull base surgery, as vital structures such as the brain, carotid arteries, optic nerves, and orbit are all in close proximity.

The CT image uploaded must be fine cut(1mm slices). Image guidance is used to confirm the correct location when resection a portion of the posterior nasal septum, and when drilling away the skull base directly inferior to the pituitary adenoma. Once the adenoma is located, the StealthStation guidance is used to demarcate the extent of skull base that must be resected in order to completely visualize and remove the tumor.