Image-guided functional endoscopic sinus surgery

Stereotactic guidance for intracranial surgery dates back to the early 1900s. Frameless stereotactic surgical navigation systems have recently been developed for functional endoscopic sinus surgery. Image-guided functional endoscopic sinus surgery provides a "real time," 3-dimensional link between the preoperative CT information and the intraoperative surgical anatomy. Transmitters are incorporated into both a patient headset and the surgical instrument(s). The transmitters allow a computer digitizer to precisely locate the patient and instrument in space. Intraoperatively, the surgeon can place the surgical instrument on intranasal structures and view the precise location on coronal, axial, and sagittal CT images in real time. Many authors feel this technique allows for a more complete surgical resection, while reducing the risk of complications. In this article an overview of image-guided technology is presented, the current literature on image-guided functional endoscopic sinus surgery is reviewed, and the advantages and disadvantages of each technique are compared.