Stereotactic Image Guided Surgery
Sinusitis is the infection of the mucosa inside the nasal cavities and facial sinuses. When the narrow sinus passageways become blocked due to congestion, mucus drainage is obstructed and infection can occur.
Sinusitis is usually caused by natural (i.e., exacerbated cold) causes and resolves over time. Acute sinusitis, however, can lead to a number of complications. All of the sinuses are near vital structures. The ethmoids and frontal sinuses are near the brain and eyes, the maxillary sinuses are under the eyes, and the sphenoid sinuses are in the back of the sinuses surrounded by a host of nerves and vessels. For this reason, methods have been developed that are directed towards making sinus surgery as safe as possible. There are many variations of sinus surgery that can be customized for each individual.
What is Stereotactic Image-Guided Surgery?
Stereotactic surgery for sinusitis is becoming increasingly prevalent as a major advance in sinus surgery technology. Stereotactic surgery involves the non-invasive three-dimensional diagramming of the sinus cavities and related structures fixed points on a 3-dimensional sinus CAT scan, magnetic probes and complex imaging algorithms.
Using stereotactic image-guided surgery (IGS) to bolster endoscopic procedures, a surgeon can make better decisions in real-time and handle operations with increased precision. By associating magnetic probes with endoscopes and surgical tools, a surgeon is able to monitor his progress in three dimensions on a computer screen while operating. Comparing the live endoscopic view of the anatomy with three different CAT scan views of that patient at the same time gives a tremendous amount of additional information.
Safety of Stereotactic Sinusitis Surgery
According to the Missouri State Medical Association (MSMA), image-guided surgical instruments in the operative field are accurate to within 2mm. The procedures also account for head movement and breathing movement (patient headset movements are tracked by the system), similar to stereotactic radiosurgery procedures developed for the treatment of cancer. Additionally, the sinuses provide the perfect environment for image-guidance probes because of their natural bony borders. Image-guided sinusitis surgery allows surgeons to avoid the most common cause of intracranial injury and complication (0%-2.50%) – human error.
Limitations of Image Guidance
The primary limitation of IGS for sinusitis patients is the higher upfront cost compared to traditional or endoscopic surgery, due to increased time expenditure on the part of the surgeon and higher capital expenses for the maintenance and repair of image-guidance technology. On average, IGS takes 17.4 minutes longer than traditional endoscopic procedures. Based on MSMA findings, the additional time and equipment expenses amount to an additional $500 per procedure. The expenses in cities and with higher-end surgical centers can be much higher.
Stereotactic Image Surgery and Insurance
Indications for stereotactic surgery are determined by boards and committees of sinus specialists. Insurance companies will generally deny new technologies as experimental until these specialty physician boards negotiate the procedure uses for patients. IGS has been in existence long enough to be covered by most insurances. The current indications include frontal and ethmoid surgery, nasal polyps, and revision sinus surgery. Dr. Bennett’s staff will check your insurance before your procedure to let you know what your benefits include.