Image-Guided Sinus Endoscopy

  • Marvin P. Fried
  • Marc J. Gibber


Over the last two decades, image guidance has become an essential component of endoscopic sinus surgery. After years of being used primarily within the neurosurgical field, image guidance has been modified to aid otolaryngologists during sinonasal and skull base procedures. While not replacing surgical skills or knowledge of anatomical structures, image guidance allows for greater operative confidence for both novice and expert surgeons. There have been two basic types of image guidance systems used in sinus surgery—an electromagnetic system and an optical system—neither of which has proven far superior to the other. With image guidance now a vital component of sinus surgery, manufacturers continue to advance technology to improve the devices. Image guidance has proven useful across a wide array of pathologies within the sinonasal cavity and skull base region, in both adult and pediatric populations. There have also been several reports on intraoperative image-guided therapy, with both CT-based and MRI-based devices being reported. Image guidance is now state of the art for sinonasal and skull base surgery and a valuable teaching tool for resident training.


Skull Base Image Guidance Sphenoid Sinus Frontal Sinus Endoscopic Sinus Surgery 
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  1. 1.
    Fried MP, Parikh SR, Sadoughi B. Image-guidance for endoscopic sinus surgery. Laryngoscope. 2008;118(7):1287–92.PubMedCrossRefGoogle Scholar
  2. 2.
    American Academy of Otolaryngology-Head and Neck Surgery. Policy on intra-operative use of computer-aided surgery. AAO-HNS Official website, policy statements. 2002.Google Scholar
  3. 3.
    Vining EM, Kennedy DW. The transmigration of endoscopic sinus surgery from Europe to the United States. Ear Nose Throat J. 1994;73:456–60.PubMedGoogle Scholar
  4. 4.
    Stammberger H. Endoscopic endonasal surgery- concepts in treatment of recurrent rhinosinusitis: part one. Anatomic and pathophysiologic considerations. Otolaryngol Head Neck Surg. 1986;94: 143–7.PubMedGoogle Scholar
  5. 5.
    Stammberger H. Endoscopic endonasal surgery- concepts in treatment of recurrent rhinosinusitis: part one. Surgical technique. Otolaryngol Head Neck Surg. 1986;94:147–56.PubMedGoogle Scholar
  6. 6.
    Anon JB. Computer-aided endoscopic sinus surgery. Laryngoscope. 1998;108:949–60.PubMedCrossRefGoogle Scholar
  7. 7.
    Bergstrom M, Greitz T. Stereotaxic computed tomography. AJR Am J Roentgenol. 1976;127:167–70.PubMedCrossRefGoogle Scholar
  8. 8.
    Brown R. A computerized tomography-computer graphics approach to stereotaxic localization. J Neurosurg. 1979;50:715–20.PubMedCrossRefGoogle Scholar
  9. 9.
    Perry JH, Rosenbaum AE, Lunsford LD, et al. Computed tomography-guided stereotactic surgery: conception and development of a new stereotactic methodology. Neurosurgery. 1980;7:376–81.PubMedCrossRefGoogle Scholar
  10. 10.
    Robert DW, Strohbehn JW, Hatch JF, et al. A frameless stereotaxic integration of computerized tomographic imaging and the operating microscope. J Neurosurg. 1986;65:545–9.CrossRefGoogle Scholar
  11. 11.
    Laborde G, Gilsbach J, Harders A, et al. Computer assisted localizer for planning surgery and intra-operative orientation. Acta Neurochir (Wien). 1992;119:166–70.CrossRefGoogle Scholar
  12. 12.
    Klimek L, Mosges R, Bartsch M. Indicatons for CAS (computer assisted surgery) systems as navigation aids in ENT surgery. In: Proceedings of the CAR’91. Berlin: Springer; 1991. p. 358–61.Google Scholar
  13. 13.
    Anon JB, Lipman SP, Oppenheim D, et al. Computer assisted endoscopic surgery. Laryngoscope. 1994;104:901–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Fried MP, Kleefield J, Gopal H, et al. Image-guided endoscopic surgery: results of accuracy and performance in a multi-center clinical study using an electromagnetic tracking system. Laryngoscope. 1997;107:594–601.PubMedCrossRefGoogle Scholar
  15. 15.
    Metson R, Gliklich RE, Cosenza M. A comparison of image guidance systems for sinus surgery. Laryngoscope. 1998;108(8 Pt 1):1164–70.PubMedCrossRefGoogle Scholar
  16. 16.
    Metson RB, Cosenza MJ, Cunningham MJ, Randolph GW. Physician experience with an optical image guidance system for sinus surgery. Laryngoscope. 2000;110:972–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Fuoco G, Chiodo A, Smith O, El Masri W, Guirgis R. Clinical experience with angulated, hand-activated, wireless instruments in an optical tracking system for endoscopic sinus surgery. J Otolaryngol. 2005;34:317–22.PubMedCrossRefGoogle Scholar
  18. 18.
    Bale RJ, Vogele M, Freysinger W, et al. Minimally invasive head holder to improve the performance of frameless stereotactic surgery. Laryngoscope. 1997;107:373–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Citardi MJ, Batra PS. Intraoperative surgical navigation for endoscopic sinus surgery: rationale and indications. Curr Opin Otolaryngol Head Neck Surg. 2007;15:23–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Chiu AG, Palmer JN, Cohen N. Use of image-guided computed tomography-magnetic resonance fusion for complex endoscopic sinus and skull base surgery. Laryngoscope. 2005;115:753–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Leong JL, Batra PS, Citardi MJ. CT-MR image fusion for the management of skull base lesions. Otolaryngol Head Neck Surg. 2006;134:868–87.PubMedCrossRefGoogle Scholar
  22. 22.
    Nakamura M, Stover T, Rodt T. Neuronavigational guidance in craniofacial approaches for large (para)nasal tumors involving the anterior skull base and anterior clival regions. Eur J Surg Oncol. 2009;35(6):666–72.PubMedCrossRefGoogle Scholar
  23. 23.
    Fried MP, Moharir VM, Shin J, Taylor-Becker M, Morrison P. Comparison of endoscopic sinus surgery with and without image guidance. Am J Rhinol. 2002;16:193–7.PubMedGoogle Scholar
  24. 24.
    Metson R. Image-guided sinus surgery: lessons learned from the first 1000 cases. Otolaryngol Head Neck Surg. 2003;128(1):8–13.PubMedCrossRefGoogle Scholar
  25. 25.
    Doshi J, Youngs R. Navigational systems in rhinology: should we all be using them? J Laryngol Otol. 2007;121:818–21.PubMedGoogle Scholar
  26. 26.
    Casiano RR, Numa Jr WA. Efficacy of computed tomographic image-guided endoscopic sinus surgery in residency training programs. Laryngoscope. 2000;110:1277–82.PubMedCrossRefGoogle Scholar
  27. 27.
    Caversaccio M, Bachler R, Ladrach K, Schroth G, Nolte LP, Hausler R. Frameless computer-aided surgery system for revision endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2000;122:808–13.PubMedCrossRefGoogle Scholar
  28. 28.
    Kacker A, Tabaee A, Anand V. Computer-assisted surgical navigation in revision endoscopic sinus surgery. Otolaryngol Clin North Am. 2005;38:473–82.PubMedCrossRefGoogle Scholar
  29. 29.
    Petruzzelli GJ, Origitano TC, Stankiewicz JA, Anderson DE. Frameless stereotactic localization in cranial base surgery. Skull Base Surg. 2000;10:125–30.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Zacharek MA, Fong KJ, Hwang PH. Image-guided frontal trephination: a minimally invasive approach for hard-to-reach frontal sinus disease. Otolaryngol Head Neck Surg. 2006;135:518–22.PubMedCrossRefGoogle Scholar
  31. 31.
    Carrau RL, Snyderman CH, Curtin HB, Weissman JL. Computer-assisted frontal sinusotomy. Otolaryngol Head Neck Surg. 1994;111:727–32.PubMedCrossRefGoogle Scholar
  32. 32.
    Innis W, Byrne P, Tufano RP. Image-guided osteoplastic frontal sinusotomy. Am J Rhinol. 2005;19:430–4.PubMedGoogle Scholar
  33. 33.
    Anand VK, Hiltzik DH, Kacker A, Honrado C. Osteoplastic flap for frontal sinus obliteration in the era of image-guided endoscopic sinus surgery. Am J Rhinol. 2005;19:406–10.PubMedGoogle Scholar
  34. 34.
    Sindwani R, Metson R. Image-guided frontal sinus surgery. Otolaryngol Clin North Am. 2005;38:461–71.PubMedCrossRefGoogle Scholar
  35. 35.
    Sindwani R, Metson R. Impact of image guidance on complications during osteoplastic frontal sinus surgery. Otolaryngol Head Neck Surg. 2004;131:150–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Otori N, Haruna S, Kamio M, et al. Endoscopic transethmosphenoidal approach for pituitary tumors with image guidance. Am J Rhinol. 2001;15(6):381–6.PubMedGoogle Scholar
  37. 37.
    Alfieri A, Jho HD. Endoscopic endonasal approaches to the cavernous sinus: surgical approaches. Neurosurgery. 2001;49(2):354–60.PubMedGoogle Scholar
  38. 38.
    Jho HD, Ha HG. Endoscopic endonasal skull base surgery: part 2 – the cavernous sinus. Minim Invasive Neurosurg. 2004;47(1):9–15.PubMedCrossRefGoogle Scholar
  39. 39.
    Jho HD, Ha HG. Endoscopic endonasal skull base surgery: part 3 – the clivus and posterior fossa cavernous sinus. Minim Invasive Neurosurg. 2004;47(1):16–23.PubMedCrossRefGoogle Scholar
  40. 40.
    Chow JM, Stankiewicz JA. Application of image-guidance to surgery of the orbit. Otolaryngol Clin North Am. 2005;38:491–503.PubMedCrossRefGoogle Scholar
  41. 41.
    White JB, Parikh SR. Early experience with image guidance in endoscopic transnasal drainage of periorbital abscesses. J Otolaryngol. 2005;34:63–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Bahtra PS, Lanza DC. Endoscopic power assisted orbital exenteration. Am J Rhinol. 2005;19(3):297–301.Google Scholar
  43. 43.
    Murchison AP, Rosen MR, Evans JJ, et al. Endoscopic approach to the orbital apex and periorbital skull base. Laryngoscope. 2011;121(3):461–7.CrossRefGoogle Scholar
  44. 44.
    Lusk R. Computer-assisted functional endoscopic sinus surgery in children. Otolaryngol Clin North Am. 2005;38:505–13.PubMedCrossRefGoogle Scholar
  45. 45.
    Postec F, Bossard D, Disant F, et al. Computer-assisted navigation system in pediatric intranasal surgery. Arch Otolaryngol Head Neck Surg. 2002;128:797–800.PubMedCrossRefGoogle Scholar
  46. 46.
    Parikh SR, Cuellar H, Sadoughi B, et al. Indications for image guidance in pediatric sinonasal surgery. Int J Pediatr Otorhinolaryngol. 2009;73(3):351–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Michaelson PG, Cable BB, Mair EA. Image-guided transsphenoidal drainage of a cholesterol granuloma of the petrous apex in a child. Int J Pediatr Otorhinolaryngol. 2001;57:165–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Mair EA, Battiata A, Casler JD. Endoscopic laser-assisted excision of juvenile nasopharyngeal angiofibromas. Arch Otolaryngol Head Neck Surg. 2003;129:454–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Benoit MM, Silvera VM, Nichollas R, et al. Image guidance systems for minimally invasive sinus and skull base surgery in children. Int J Pediatr Otorhinolaryngol. 2009;73:1452–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Metson R, Cosenza M, Gliklich RE, Montgomery WW. The role of image guidance systems for head and neck surgery. Arch Otolaryngol Head Neck Surg. 1999;125:1100–4.PubMedCrossRefGoogle Scholar
  51. 51.
    Javer AR, Genoway KA. Patient quality of life improvements with and without computer assistance in sinus surgery: outcomes study. J Otolaryngol. 2006;35:373–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Tabaee A, Hsu AK, Shrime MG, et al. Quality of life and complications following image guided endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2006;135:76–80.PubMedCrossRefGoogle Scholar
  53. 53.
    Tabaee A, Kassenoff TL, Kacker A, Anand VK. The efficacy of computer assisted surgery in the endoscopic management of cerebrospinal fluid rhinorrhea. Otolaryngol Head Neck Surg. 2005;133:936–43.PubMedCrossRefGoogle Scholar
  54. 54.
    Hwang PH, Maccabee M, Lindgren JA. Headset-related sensory and motor neuropathies in image-guided sinus surgery. Arch Otolaryngol Head Neck Surg. 2002;128:589–91.PubMedCrossRefGoogle Scholar
  55. 55.
    Smith TL, Stewart MG, Orlandi RR, et al. Indications for image-guided sinus surgery: the current evidence. Am J Rhinol. 2007;212(1):80–3.CrossRefGoogle Scholar
  56. 56.
    Fried MP, Topulos G, Hsu L, et al. Endoscopic sinus surgery with magnetic resonance imaging guidance: initial patient experience. Otolaryngol Head Neck Surg. 1998;119:374–80.PubMedCrossRefGoogle Scholar
  57. 57.
    Fried MP, Hsu L, Topulos GP, Jolesz FA. Image-guided surgery in a new magnetic resonance suite: preclinical considerations. Laryngoscope. 1996;106:411–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Hsu L, Fried MP, Jolesz FA. MR-guided endoscopic sinus surgery. AJNR Am J Neuroradiol. 1998;19:1235–40.PubMedGoogle Scholar
  59. 59.
    Jolesz FA, Morrison PR, Koran SJ, et al. Compatible instrumentation for intraoperative MRI: expanding resources. J Magn Reson Imaging. 1998;8:8–11.PubMedCrossRefGoogle Scholar
  60. 60.
    Suzuki M, Sakurai H, Seno S, et al. Use of real-time magnetic resonance image guidance in endoscopic sinus surgery. Minim Invasive Ther Allied Technol. 2005;14:376–84.PubMedCrossRefGoogle Scholar
  61. 61.
    Anand VK, Schwartz TH, Hiltzik DH, Kacker A. Endoscopic transsphenoidal pituitary surgery with real-time intraoperative magnetic resonance imaging. Am J Rhinol. 2006;20:401–5.PubMedCrossRefGoogle Scholar
  62. 62.
    Rafferty MA, Siewerdsen JH, Chan Y, et al. Intraoperative cone-beam CT for guidance of temporal bone surgery. Otolaryngol Head Neck Surg. 2006;134:801–8.PubMedCrossRefGoogle Scholar
  63. 63.
    Rafferty MA, Siewerdsen JH, Chan Y, et al. Investigation of C-arm cone-beam CT-guided surgery of the frontal recess. Laryngoscope. 2005;115:2138–43.PubMedCrossRefGoogle Scholar
  64. 64.
    Brown SM, Sadoughi B, Cuellar H, von Jako R, Fried MP. Feasibility of near real-time image-guided sinus surgery using intraoperative fluoroscopic computed axial tomography. Otolaryngol Head Neck Surg. 2007;136:268–73.PubMedCrossRefGoogle Scholar
  65. 65.
    Manarey CR, Anand VK. Radiation dosimetry of the FlouroCAT scan for real-time endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2006;135(3):409–12.PubMedCrossRefGoogle Scholar
  66. 66.
    Wise SK, Harvey RJ, Goddard JC, et al. Combine image guidance and intraoperative computed tomography in facilitating endoscopic orientation within and around the paranasal sinuses. Am J Rhinol. 2008;22(6):635–41.PubMedCrossRefGoogle Scholar
  67. 67.
    Jackman AH, Palmer JN, Chiu AG, et al. Use of intraoperative CT scanning in endoscopic sinus surgery: a preliminary report. Am J Rhinol. 2008;22(2):170–4.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of OtolaryngologyMontefiore Medical Center, Albert Einstein College of MedicineBronxUSA
  2. 2.Department of Otorhinolaryngology-Head and Neck SurgeryMontefiore Medical Center, Albert Einstein College of MedicineBronxUSA

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