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 sinus inflammation and will generally resolve over time with conservative treatment. Acute sinusitis, however, can sometimes fail to resolve which can lead to chronic sinusitis and a number of other complications. All of the sinuses are located 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, sinus surgery techniques and technology have progressed towards making sinus surgery as safe as possible. Techniques and specialized equipment for sinus surgery can be tailored for each patient’s sinus concerns.
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 mapping the three-dimensional anatomy of the sinus cavities with a sinus CAT scan so that the actual anatomy can be used during surgery. This involves using laser surface verification, magnetic probes and complex mathematical imaging algorithms.
Using stereotactic image-guided surgery (IGS) with modern endoscopic sinus surgery procedures, a surgeon can make decisions and verify anatomy in real-time. By registering magnetic probes with endoscopes and surgical tools, a surgeon is able to monitor his progress in three dimensions on a computer screen while he compares sinus anatomy with a magnified view inside the nose. Comparing the live endoscopic view of the anatomy with three different CAT scan views of that patient at the same time can provide a tremendous amount of additional information.
Safety of Stereotactic Sinusitis Surgery
Image-guided surgical instruments in the operative field are accurate to approximately 2mm. The procedure also accounts for head movement and breathing movement with patient headset movements tracked by the system. This is 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.
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 with the additional time and equipment expenses amounting 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 sphenoid 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.