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Image Guided Sinus Surgery
by Richard W. Clark, M.D.
When you have problems with your nasal passages, it’s like having a cold that doesn’t ever go away. Allergies, nasal polyps and sinusitis are among the problems that can lead to such breathing difficulties. Now patients treated at Good Samaritan Hospital can literally breathe easier, thanks to a sophisticated new image guidance technology.
Image Guided Endoscopic Sinus Surgery (ESS), has already proven to be a safer, more effective approach than traditional ESS. This surgical technique, available at Good Samaritan Hospital, has quickly become known in quality medical circles as the wave of the future for the effective treatment for sinus problems. ESS is performed under either local or general anesthesia and usually requires either an outpatient or one night hospital stay. It is approved for reimbursement by most health insurance organizations.
Minimally invasive surgery is used when the body’s interior structures can be reached with a surgical instrument through natural openings, such as the nostrils, or when only a small incision is needed.
Image-guided ESS combines CT scans with a sophisticated computerized guidance system so that the source of the sinus trouble can be precisely addressed. The three-dimensional image created by the guidance system allows the surgeon to conduct the surgery via an exacting view of the patient’s skull anatomy.
Traditional endoscopic surgery has until now been the leading method of correcting sinus problems. For traditional ESS, the surgeon has to correlate details of the patient’s anatomy from the more limited two-dimensional CT scan. The endoscope, the surgical tool used in this operation, is like a miniature telescope that illuminates the surgeon’s view of the nasal passages. Still, many anatomical structures are obstructed from view.
The image-guided approach improves upon the best features of ESS, allowing the surgeon not only to view the anatomy in real time, but also in three dimensions - face-on, from the side, and from below. This gives the surgeon visualization of the deeper structures, making it possible to more precisely pinpoint and eliminate disease.
On the computer monitor, the endoscopic tool is viewed as a set of cross hairs, which indicate the precise movements of the surgical tools as repairs of the sinus cavity are being performed. It also shows the doctor exactly where the surgical tool is in relation to the sinus cavity and the surrounding structures. This degree of accuracy helps protect the delicate adjoining areas, such as the brain and eyes, reducing the chance of complications.
In advance of surgery, the patient is scheduled for a CT scan in the Radiology Department. After removing any metal worn near the head, such as eyeglasses or jewelry, the patient puts on a special disposable headset with earpieces. This customized headset, also worn during surgery, allows the computer’s software to develop a precise model of each individual’s skull anatomy from the CT scan. In the operating room these coordinates serve as a guide for the surgeon, ensuring each patient of the utmost precision in treatment.
Recovery is rapid, with most patients returning home a few hours after surgery and often resuming normal activities within a day or two.
