Virtual Endoscopy and 3-D Reconstruction in the Nose, Paranasal Sinuses, and Skull Base Surgery: New Frontiers

  • Shanmugam GanesanEmail author
  • Hamad Al Saey
  • Natarajan Saravanappa
  • Prathamesh Pai
  • Surjith Vattoth
  • Michael Stewart


Innovations and advances in digital technology have helped to enhance preoperative diagnostic workup and precise surgical management of various pathologies in innately complex anatomical regions such as skull base lesions. These advancements have provided the medical fraternity yet another tool in their armamentarium in their thirst to conquer surgical fields. Virtual endoscopy provides understanding of anatomical structures and lesions in hidden areas. 3-D reconstruction and 3-D printing enable us to evaluate the extent of disease and help in effective planning of surgical approach. The virtual endoscopy and 3-D printing technology have allowed us to explain to patients the disease process and the surgical intervention enabling us to obtain informed consent. In view of these innovations, surgical training has also been revolutionized which would help future generations of surgical trainees to be trained in complex surgical procedures in a virtual environment. This chapter explores the advantages of virtual endoscopy, 3-D reconstruction, and 3-D printing in the field of paranasal sinuses and skull base surgery. These technologies would be of immense value in preoperative planning, patient education, surgical training, and precise surgical interventions. We sincerely hope that these new frontiers would improve the surgical outcome for the betterment of our patients and enhance surgical approach and training of future surgeons.


Virtual endoscopy Skull base surgery 3-D reconstruction 3-D printing Training Education 


  1. 1.
    Anand SM, Frenkiel S, Le BQH, Glikstein R. Virtual endoscopy: our next major investigative modality? J Otolaryngol Head Neck Surg. 2009;38(6):642–5.PubMedGoogle Scholar
  2. 2.
    Han P, Pirsig W, Ilgen F, Görich J, Sokiranski R. Virtual endoscopy of the nasal cavity in comparison with fiberoptic endoscopy. Eur Arch Otorhinolaryngol. 2000;257(10):578–83.PubMedGoogle Scholar
  3. 3.
    Kettenbach J, Birkfellner W, Rogalla P. Virtual endoscopy of the paranasal sinuses. In:Image processing in radiology. Berlin, Heidelberg: Springer; 2008. p. 151–71.. (Medical Radiology). Scholar
  4. 4.
    Parikh SS, Chan S, Agrawal SK, Hwang PH, Salisbury CM, Rafii BY, et al. Integration of patient-specific paranasal sinus computed tomographic data into a virtual surgical environment. Am J Rhinol Allergy. 2009;23(4):442–7.PubMedGoogle Scholar
  5. 5.
    Farneti P, Riboldi A, Sciarretta V, Piccin O, Tarchini P, Pasquini E. Usefulness of three-dimensional computed tomographic anatomy in endoscopic frontal recess surgery. Surg Radiol Anat. 2017;39(2):161–8.PubMedGoogle Scholar
  6. 6.
    Patel NS, Dearking AC, O’Brien EK, Pallanch JF. Virtual mapping of the frontal recess: guiding safe and efficient frontal sinus surgery. Otolaryngol Head Neck Surg. 2017;156(5):946–51.PubMedGoogle Scholar
  7. 7.
    Nakasato T, Katoh K, Ehara S, Tamakawa Y, Hayakawa Y, Chiba H, et al. Virtual CT endoscopy in determining safe surgical entrance points for paranasal mucoceles. J Comput Assist Tomogr. 2000;24(3):486–92.PubMedGoogle Scholar
  8. 8.
    Glaser AY, Hall CB, Uribe SJI, Fried MP. Medical students’ attitudes toward the use of an endoscopic sinus surgery simulator as a training tool. Am J Rhinol. 2006;20(2):177–9.PubMedGoogle Scholar
  9. 9.
    Anand S, Frenkiel RV. Virtual endoscopy of the nasal cavity and the paranasal sinuses. Adv Endosc Surg. 2011.
  10. 10.
    Solyar A, Cuellar H, Sadoughi B, Olson TR, Fried MP. Endoscopic sinus surgery simulator as a teaching tool for anatomy education. Am J Surg. 2008;196(1):120–4.PubMedGoogle Scholar
  11. 11.
    Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg. 2002;236(4):458–63; discussion 463-464PubMedPubMedCentralGoogle Scholar
  12. 12.
    Kapakin S. The paranasal sinuses: three-dimensional reconstruction, photo-realistic imaging, and virtual endoscopy. Folia Morphol (Warsz). 2016;75(3):326–33.Google Scholar
  13. 13.
    Arora A, Lau LYM, Awad Z, Darzi A, Singh A, Tolley N. Virtual reality simulation training in otolaryngology. Int J Surg Lond Engl. 2014;12(2):87–94.Google Scholar
  14. 14.
    Edmond CV. Impact of the endoscopic sinus surgical simulator on operating room performance. Laryngoscope. 2002;112(7 Pt 1):1148–58.PubMedGoogle Scholar
  15. 15.
    Andolfi C, Plana A, Kania P, Banerjee PP, Small S. Usefulness of three-dimensional modeling in surgical planning, resident training, and patient education. J Laparoendosc Adv Surg Tech A. 2017;27(5):512–5.PubMedGoogle Scholar
  16. 16.
    Agbetoba A, Luong A, Siow JK, Senior B, Callejas C, Szczygielski K, et al. Educational utility of advanced three-dimensional virtual imaging in evaluating the anatomical configuration of the frontal recess. Int Forum Allergy Rhinol. 2017;7(2):143–8.PubMedGoogle Scholar
  17. 17.
    Thomas L, Pallanch JF. Three-dimensional CT reconstruction and virtual endoscopic study of the ostial orientations of the frontal recess. Am J Rhinol Allergy. 2010;24(5):378–84.PubMedGoogle Scholar
  18. 18.
    Dearking AC, Pallanch JF. Mapping the frontal sinus ostia using virtual endoscopy. Laryngoscope. 2012;122(10):2143–7.PubMedGoogle Scholar
  19. 19.
    Belina S, Cuk V, Klapan I. Virtual endoscopy and 3-D volume rendering in the management of frontal sinus fractures. Coll Antropol. 2009;33(Suppl 2):43–51.PubMedGoogle Scholar
  20. 20.
    Fujikura T, Tanaka N, Sugiura E, Ide N, Miyajima K. Clinical application of virtual endoscopy as a support system for endoscopic sinus surgery. Acta Otolaryngol. 2009;129(6):674–80.PubMedGoogle Scholar
  21. 21.
    Wolfsberger S, Forster M-T, Donat M, Neubauer A, Bühler K, Wegenkittl R, et al. Virtual endoscopy is a useful device for training and preoperative planning of transsphenoidal endoscopic pituitary surgery. Minim Invasive Neurosurg. 2004;47(4):214–20.PubMedGoogle Scholar
  22. 22.
    Rotariu DI, Ziyad F, Budu A, Poeata I. The role of osiriX based virtual endoscopy in planning endoscopic transsphenoidal surgery for pituitary adenoma. Turk Neurosurg. 2017;27(3):339–45.PubMedGoogle Scholar
  23. 23.
    Zheng J-P, Li C-Z, Chen G-Q, Song G-D, Zhang Y-Z. Three-dimensional printed skull base simulation for transnasal endoscopic surgical training. World Neurosurg. 2018;111:e773–82.PubMedGoogle Scholar
  24. 24.
    Haerle SK, Daly MJ, Chan H, Vescan A, Witterick I, Gentili F, et al. Localized intraoperative virtual endoscopy (LIVE) for surgical guidance in 16 skull base patients. Otolaryngol Head Neck Surg. 2015;152(1):165–71.PubMedGoogle Scholar
  25. 25.
    Mert A, Micko A, Donat M, Maringer M, Buehler K, Sutherland GR, et al. An advanced navigation protocol for endoscopic transsphenoidal surgery. World Neurosurg. 2014;82(6 Suppl):S95–105.PubMedGoogle Scholar
  26. 26.
    Oishi M, Fukuda M, Yajima N, Yoshida K, Takahashi M, Hiraishi T, et al. Interactive presurgical simulation applying advanced 3D imaging and modeling techniques for skull base and deep tumors. J Neurosurg. 2013;119(1):94–105.PubMedGoogle Scholar
  27. 27.
    Yunus M. Helical CT scan with 2D and 3D reconstructions and virtual endoscopy versus conventional endoscopy in the assessment of airway disease in neonates, infants and children. J Pak Med Assoc. 2012;62(11):1154–60.PubMedGoogle Scholar
  28. 28.
    Kwong KM. Current updates on choanal atresia. Front Pediatr. 2015;3:52.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Ganguli A, Pagan-Diaz GJ, Grant L, Cvetkovic C, Bramlet M, Vozenilek J, et al. 3D printing for preoperative planning and surgical training: a review. Biomed Microdevices. 2018;20(3):65.PubMedGoogle Scholar
  30. 30.
    Crafts TD, Ellsperman SE, Wannemuehler TJ, Bellicchi TD, Shipchandler TZ, Mantravadi AV. Three-dimensional printing and its applications in otorhinolaryngology-head and neck Surgery. Otolaryngol Head Neck Surg. 2017;156(6):999–1010.PubMedGoogle Scholar
  31. 31.
    Naftulin JS, Kimchi EY, Cash SS. Streamlined, inexpensive 3D printing of the brain and skull. PLoS ONE. 2015;10(8):e0136198.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Rengier F, Mehndiratta A, von Tengg-Kobligk H, Zechmann CM, Unterhinninghofen R, Kauczor H-U, et al. 3D printing based on imaging data: review of medical applications. Int J Comput Assist Radiol Surg. 2010;5(4):335–41.PubMedGoogle Scholar
  33. 33.
    Zhong N, Zhao X. 3D printing for clinical application in otorhinolaryngology. Eur Arch Otorhinolaryngol. 2017;274(12):4079–89.PubMedGoogle Scholar
  34. 34.
    Muelleman TJ, Peterson J, Chowdhury NI, Gorup J, Camarata P, Lin J. Individualized surgical approach planning for petroclival tumors using a 3D printer. J Neurol Surg B Skull Base. 2016;77(3):243–8.PubMedGoogle Scholar
  35. 35.
    Grau S, Kellermann S, Faust M, Perrech M, Beutner D, Drzezga A, et al. Repair of cerebrospinal fluid leakage using a transfrontal, radial adipofascial flap: an individual approach supported by three-dimensional printing for surgical planning. World Neurosurg. 2018;110:315–8.PubMedGoogle Scholar
  36. 36.
    Cui J, Chen L, Guan X, Ye L, Wang H, Liu L. Surgical planning, three-dimensional model surgery and preshaped implants in treatment of bilateral craniomaxillofacial post-traumatic deformities. J Oral Maxillofac Surg. 2014;72(6):1138.e1–14.Google Scholar
  37. 37.
    Mustafa SF, Evans PL, Bocca A, Patton DW, Sugar AW, Baxter PW. Customized titanium reconstruction of post-traumatic orbital wall defects: a review of 22 cases. Int J Oral Maxillofac Surg. 2011;40(12):1357–62.PubMedGoogle Scholar
  38. 38.
    Park SH, Yun BG, Won JY, Yun WS, Shim JH, Lim MH, et al. New application of three-dimensional printing biomaterial in nasal reconstruction. Laryngoscope. 2017;127(5):1036–43.PubMedGoogle Scholar
  39. 39.
    Choi YD, Kim Y, Park E. Patient-specific augmentation rhinoplasty using a three-dimensional simulation program and three-dimensional printing. Aesthet Surg J. 2017;37(9):988–98.PubMedGoogle Scholar
  40. 40.
    Bekisz JM, Liss HA, Maliha SG, Witek L, Coelho PG, Flores RL. In-house manufacture of sterilizable, scaled, patient-specific 3D-printed models for rhinoplasty. Aesthet Surg J. 2018;39(3):254–63.Google Scholar
  41. 41.
    Darwood A, Collier J, Joshi N, Grant WE, Sauret-Jackson V, Richards R, et al. Re-thinking 3D printing: a novel approach to guided facial contouring. J Craniomaxillofac Surg. 2015;43(7):1256–60.PubMedGoogle Scholar
  42. 42.
    AlReefi MA, Nguyen LH, Mongeau LG, Bu H, Boyanapalli S, Hafeez N, et al. Development and validation of a septoplasty training model using 3‐dimensional printing technology. Int Forum Allergy Rhinol. 2017;7(4):399–404.PubMedGoogle Scholar
  43. 43.
    Ploch CC, Mansi CSSA, Jayamohan J, Kuhl E. using 3d printing to create personalized brain models for neurosurgical training and preoperative planning. World Neurosurg. 2016;90:668–74.PubMedGoogle Scholar
  44. 44.
    Vakharia VN, Vakharia NN, Hill CS. Review of 3-dimensional printing on cranial neurosurgery simulation training. World Neurosurg. 2016;88:188–98.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Shanmugam Ganesan
    • 1
    • 2
    Email author
  • Hamad Al Saey
    • 1
    • 2
  • Natarajan Saravanappa
    • 3
  • Prathamesh Pai
    • 4
  • Surjith Vattoth
    • 5
    • 6
  • Michael Stewart
    • 7
  1. 1.Otolaryngology-Head and Neck Surgery Division, Department of SurgeryHamad Medical CorporationDohaQatar
  2. 2.Department of Otolaryngology-Head and Neck SurgeryWeill Cornell Medicine-QatarDohaQatar
  3. 3.Department of Otorhinolaryngology-Head and Neck SurgeryUniversity Hospitals of North MidlandsStoke-on-TrentUK
  4. 4.Tata Memorial CentreHomi Bhabha National InstituteMumbaiIndia
  5. 5.Department of Clinical Radiology and Medical ImagingHamad Medical CorporationDohaQatar
  6. 6.Department of Clinical RadiologyWeill Cornell Medicine-QatarDohaQatar
  7. 7.Department of Otolaryngology-Head and Neck SurgeryWeill Cornell Medical College, NewYork-Presbyterian Hospital/Weill Cornell Medical CenterNew YorkUSA

Personalised recommendations