For complex or revision sinus surgery, there is a three-dimensional mapping system that can be used during surgery. This allows the surgeon another tool to verify surgical landmarks inside the sinuses at any time during the procedure. Stereotactic Image Guided Sinus Surgery combines a previous computed tomography (CT) scan and real-time information about the exact position of surgical instruments. Infrared signals help map the facial structures which are compared to the known CAT scan to provide a near match. This allows the surgeon to more accurately navigate instruments through complex sinus passages by allowing more precise intranasal localization of surgical instruments.
Dr. Bennett can see the CT scan in three dimensions while viewing the sinus structures through a camera on a large LCD monitor. The tip of the instrument is seen as a point on the CT scan in 3-dimensions. Concurrently, a camera shows real-time intranasal anatomy and progression of the surgery. The additional knowledge of location can allow for a more effective surgery in selected patients.
Stereotactic Image Guided Sinus Surgery Indications
Not all sinus surgeries require stereotactic image guidance. Image guidance is best used for surgery on the frontal sinuses, sphenoid sinuses, nasal polyps, or revision sinus surgery:
1. Frontal sinuses may have complicated entrances with the entrance located adjacent to the eyes and brain.
2. Sphenoid sinuses are bordered by the brain, the carotid artery and multiple important nerves including for the eyes.
3. Nasal polyps can obscure or remodel existing anatomy. Stereotactic Image Guided Sinus Surgery can be used to prevent disorientation when normal anatomy is difficult to determine.
4. Revision sinus surgery may have normal anatomy removed and additional localization can be valuable.
Dr. Bennett individualizes every patient’s care. A minimum of half an hour is needed to fully understand your expectations and to get a complete history and evaluation of the inside and outside of your nose. Knowing what to expect will make the entire experience more pleasant and increase your satisfaction with the surgical results. Dr. Bennett will discuss the cosmetic and functional expectations of your surgery in detail to make sure all of your questions are answered. Depending on whether you have functional/breathing issues insurance may cover part of your surgery.
Stereotactic Image Guided Sinus Surgery
BrainLAB® Stereotactic Imaging Equipment
Dr. Bennett receives a three-dimensional scan on CD with every patient’s CT scan, saving you the time and expense of obtaining a separate scan later. The CD is covered by insurance at no additional charge. Most sinus CAT scans require pre-certification. Dr. Bennett’s staff will usually be able to not only pre-certify your sinus CT scan while you are at your office visit, we can also schedule your CT scan on the same visit at an imaging center less than a block away from our office. Most patients will have their CT scan performed in less than one hour.
The week after the procedure it is normal to have a mild headache for a day or two. You will be given some pain medicine, although most patients take only one or two doses and then switch to an over the counter pain medication. If you see scant, reddish fluid draining from the nose, you should place a dressing under the nostrils to avoid sniffling. You will probably feel a lot of congestion, although some people can breathe very well immediately after surgery. You may have bruising and swelling around the nose and eyes. This will start to resolve within a few days. Most swelling will go down after a couple of weeks, but changes in the nose can continue for a year or more. You will return to the office one week after surgery to have the nasal dressing removed, then return as needed to have the nose checked. Avoid strenuous exercise for three weeks. Avoid wearing glasses for six weeks.
Image Guided Surgery Case #1
This 53-year-old female suffered from severe nasal polyps for 10 years. She was unable to breathe from the left side of her nose and slept very poorly. Her polyps pushed the septum to the right and extended from the nostril on the left. Stereotactic Image Guided Sinus Surgery was used to remove polyps from all of her sinuses. In the week following surgery, the patient’s breathing had significantly improved. She also reported a significant boost in her energy level. At a recent 5 year follow-up, she remains polyp and sinusitis free.
Stereotactic image guided sinus surgery with removal of nasal polyps in the left sphenoid sinus. Clockwise from top left: Live video of the nose interior; axial (top of head) view of patient’s CT scan; coronal (front of head) view of patient’s CT scan; sagittal (side of head) view of patient’s CT scan.
Image Guided Surgery Case #2
This 27-year-old male had had 4 previous sinus surgeries with multiple surgeons. He continued to have yellow nasal discharge from his left frontal sinus. Nasal endoscopy and review of his CT scan showed that he had an isolated sinus cell (agar nasi cell) blocking the left frontal sinus. Stereotactic Image Guided Sinus Surgery was used to assist in removing the blocked sinus and curing his sinusitis.
Stereotactic Image Guided Sinus Surgery showing the probe inside left frontal sinus open after removal of the infected cell.