Skull Base 2006; 16 - A055
DOI: 10.1055/s-2006-958588

Computer-Assisted Surgery of the Paranasal Sinuses—Technical and Clinical Experiences with the VectorVision® Compact Navigation System in 368 Patients

H. Hagedorn 1(presenter), K. Stelter 1, Andreas Leunig 1, Michaela Andratschke 1
  • 1Munich, Germany

Introduction: The following paper presents our experiences with a navigation system for functional endoscopic sinus surgery. In this study we take particular note of the indications and risks for surgery, the precision of the measurements required, and the set-up time necessary. We present one brief case report as an example.

Materials and Methods: The functional endoscopic sinus surgeries were carried out between 2000 and 2004 in the department of otorhinolaryngology of the Ludwig-Maximilians-University, Munich, on 368 patients. We used the VectorVision® Compact Navigation System from the BrainLAB company (Munich, Germany) with a laser registration. The indications for surgery ranged from severe nasal polyps to chronic sinusitis and to malignant tumors in the paranasal sinuses and skull base.

Results: The time for data preparation was less than 5 minutes. The time spent on the setup and patient registration depended on the registration method and the experience of the user. In the latter cases it took 11 minutes with the z-touch® registration. The clinical plausibility test produced a deviation of 1.3 mm on average. Complications with the system were an intraoperative reregistration (18%) and one complete failure (5%). Despite the assistance of an accurate working computer the anterior ethmoidal artery was incised in one case. However, in 368 cases we had no CSF leak, no optic nerve lesion, no retrobulbar hematoma, no intracerebral bleeding, and no deaths.

Discussion: According to our experience with computer-guided surgical procedures, we can state that computer-guided navigational systems are so accurate that the risk of misleading the surgeon is minimal. In the future their use in some special procedures will not only be sensible, but necessary. We recommend their use not only in difficult surgical situations, but also in routine procedures and for surgical training.