Navigation of Sinus and Skull Base Surgery

  • Sarah M. Kidwai
  • Arjun K. Parasher
  • Joshua B. Bederson
  • Satish Govindaraj


Given the complexity of the anatomy, proximity of critical orbital, vascular, and intracranial structures, diversity of pathology, and small surgical field, sinus and skull base surgery has often been limited by the degree of visualization and access. The nasal endoscope, initially introduced in the early nineteenth century by Hirschmann, and then developed into the modern rigid endoscope in the 1960s, revolutionized sinus and skull base surgery. Yet, its simple two-dimensional view impairs depth perception, hand-eye coordination, and size estimation. With the evolution of digital technology and the advent of computerized tomography (CT) or magnetic resonance imaging (MRI) navigation technology, a new era of surgical approaches has developed. These new technologies enable enhanced surgical visualization, detailed anatomical guidance, and accurate localization during surgical instrumentation. Combined, these technologies have expanded the scope of endoscopic surgery, while improving clinical outcomes. In this chapter, we describe the relevant sinus and skull base anatomy encountered during navigation-based endoscopic procedures and review the history, development, and future directions within the field.


Endoscopic sinus surgery Skull base surgery Image-guided surgery Navigation technology 


  1. 1.
    Lund V. The evolution of surgery on the maxillary sinus for chronic rhinosinusitis. Laryngoscope. 2002;112:415–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Vining EM, Kennedy DW. The transmigration of endoscopic sinus surgery from Europe to the United States. ENT J. 1994;73:456–60.Google Scholar
  3. 3.
    Stammberger H. The evolution of functional endoscopic sinus surgery. ENT J. 1994;73:451–5.Google Scholar
  4. 4.
    Kuhn FA. Chronic frontal sinusitis: the endoscopic frontal recess approach. Operat Tech Otolaryngol Head Neck Surg. 1996;7:222–9.CrossRefGoogle Scholar
  5. 5.
    Kim HU, Kim SS, Kang SS, Chung IH, Lee JG, Yoon JH. Surgical anatomy of the natural ostium of the sphenoid sinus. Laryngoscope. 2001;111:1599–602.CrossRefPubMedGoogle Scholar
  6. 6.
    Zinreich SJ, Benson ML, Oliverio PS. Sinonasal cavities: CT normal anatomy, imaging of the osteomeatal complex, and functional endoscopic surgery. In: Som P, Curtin H, editors. Head and Neck Imaging. 3rd ed. St. Louis: Mosby; 1996.Google Scholar
  7. 7.
    Mettler FA. Chapter 1: Introduction. In: Mettler FA, editor. Essentials of Radiology. Third ed. Philadelphia: Saunders by Elsevier; 2014.Google Scholar
  8. 8.
    Johnson DW, Hopkins RJ, Hanafee WN, Fisk JD. The unprotected parasphenoidal carotid artery studied by high-resolution computed tomography. Radiology. 1985;155:137.CrossRefPubMedGoogle Scholar
  9. 9.
    Delano M, Fun FY, Zinreich SJ. Optic nerve relationship to the posterior paranasal sinuses: a CT anatomic study. AJNR Am J Neuroradiol. 1996;17:669.PubMedGoogle Scholar
  10. 10.
    Kennedy DW. Functional endoscopic sinus surgery: technique. Arch Otolaryngol. 1985;111:643–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Messerklinger W. Endoscopy of the Nose. Baltimore: Urban & Schwarzenberg; 1978.Google Scholar
  12. 12.
    Stammberger H. Endoscopic endonasal surgery – concepts in treatment of recurring rhinosinusitis. Part I. Anatomic and pathophysiologic considerations. Otolaryngol Head Neck Surg. 1986;94:143–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Caldwell GW. The accessory sinus of the nose, and an improved method of treatment for suppuration of the maxillary antrum. N Y Med J. 1893;58:526–8.Google Scholar
  14. 14.
    Tange RA. Some historical aspects of the surgical treatment of the infected maxillary sinus. Rhinology. 1991;29:155–62.PubMedGoogle Scholar
  15. 15.
    Hosemann W, Gode U, Wagner W. Epidemiology, pathophysiology of nasal polyposis, and spectrum of endonasal sinus surgery. Am J Otolaryngol. 1994;15:85–98.CrossRefPubMedGoogle Scholar
  16. 16.
    Palmer O, Moche JA, Matthews S. Endoscopic surgery of the nose and paranasal sinus. Oral Maxillofac Surg Clin N Am. 2012;24:275–83.CrossRefGoogle Scholar
  17. 17.
    Al-Swiahb JN, Al Dousary SH. Computer-aided endoscopic sinus surgery: a retrospective comparative study. Ann Saudi Med. 2010;30:149–52.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Sindwani R. Image-guided surgery of the paranasal sinuses and skull base. Mo Med. 2008;105:257–61.PubMedGoogle Scholar
  19. 19.
    Schlöndorff G, Mosges R, Meyer-Ebrecht D, Krybus W, Adams L. CAS (computer assisted surgery). A new procedure in head and neck surgery. HNO. 1989;37:187–90.PubMedGoogle Scholar
  20. 20.
    Anon JB, Rontal M, Zinreich SJ. Computer-assisted endoscopic sinus surgery-current experience and future developments. Op Tech Otolaryngol Head Neck Surg. 1995;6:163–70.CrossRefGoogle Scholar
  21. 21.
    Sindwani R, Bucholz R. The next generation of navigational technology. Otolaryngol Clin N Am. 2005;38:551–62.CrossRefGoogle Scholar
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    Ceylan S, Koc K, Anik I. Extended endoscopic approaches for midline skull-base lesions. Neurosurg Rev. 2009;32:309–19.CrossRefPubMedGoogle Scholar
  24. 24.
    Ahn JY, Jung JY, Kim J, Lee KS, Kim SH. How to overcome the limitations to determine the resection margin of pituitary tumours with low-field intra-operative MRI during trans-sphenoidal surgery: usefulness of gadolinium-soaked cotton Pledgets. Acta Neurochir. 2008;150:763–71.CrossRefPubMedGoogle Scholar
  25. 25.
    Metson R, Gliklich RE, Cosenza M. A comparison of image guidance systems for sinus surgery. Laryngoscope. 1998;108:1164–70.CrossRefPubMedGoogle Scholar
  26. 26.
    Knott PD, Batra PS, Citardi MJ. Computer aided surgery: concepts and applications in rhinology. Otolaryngol Clin North Am. 2006;39:503–22.CrossRefPubMedGoogle Scholar
  27. 27.
    Irugu DVK, Stammberger HR. A note on the technical aspects and evaluation of the role of navigation system in endoscopic endonasal surgeries. Indian J Otolaryngol Head Neck Surg. 2014;66:S307–13.CrossRefGoogle Scholar
  28. 28.
    Reardon EJ. The impact of image-guidance systems on sinus surgery. Otolaryngol Clin N Am. 2005;38:515–25.CrossRefGoogle Scholar
  29. 29.
    Tabaee A, Hsu AK, Shrime MG, Rickert S, Close LG. Quality of life and complications following image-guided endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2006;135:76–80.CrossRefPubMedGoogle Scholar
  30. 30.
    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.CrossRefPubMedGoogle Scholar
  31. 31.
    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.PubMedCrossRefGoogle Scholar
  32. 32.
    Sindwani R, Metson R. Impact of image-guidance on complications during osteoplastic frontal sinus surgery. Otolaryngol Head Neck Surg. 2004;131:150–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Sindwani R, Metson R. Image-guided frontal sinus surgery. Otolaryngol Clin N Am. 2005;38:461–71.CrossRefGoogle Scholar
  34. 34.
    Sadoughi B, Brown SM, Nachlas NE, Fried MP Image-guided surgery. (2010). Accessed 7 Apr 2014.
  35. 35.
    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.CrossRefPubMedGoogle Scholar
  36. 36.
    Jackman AM, Palmer IN, Hiv AG, Kennedy DW. Use of intraoperative CT scanning in endoscopic sinus surgery: a preliminary report. AM J Rhinol. 2008 Mar–Apr;22(2):170–4.CrossRefPubMedGoogle Scholar
  37. 37.
    O’Malley BW Jr, Weinstein GS. Robotic skull base surgery. Arch Otolaryngol Head Neck Surg. 2007;133:1215–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sarah M. Kidwai
    • 1
  • Arjun K. Parasher
    • 1
  • Joshua B. Bederson
    • 2
  • Satish Govindaraj
    • 1
  1. 1.Department of OtolaryngologyThe Mount Sinai Hospital, Icahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Department of Neurosurgery, The Mount Sinai HospitalIcahn School of Medicine at Mount SinaiNew YorkUSA

Personalised recommendations