Historical perspective on image-guided sinus surgery

Image-guided sinus surgery has developed over the course of many years. It began with framed stereotaxy using plain radiography and fluoroscopy, and has continued to incorporate new imaging technologies as they appear. The technology received a significant boost with the advent of computed tomography (CT), and currently magnetic resonance imaging (MRI) is being incorporated to open new frontiers. Although initially driven by neurosurgical applications, sinus surgery was recognized early on to be an ideal environment for the application of computer-assisted surgical navigation, because the bony framework of the sinuses would limit the soft tissue shift that would adversely affect the accuracy of guidance based on preoperative imaging. Perhaps more importantly, particularly for the experienced surgeon, the image guidance machines have dramatically improved preoperative planning in addition to providing intraoperative data. Although the accuracy and reliability of computer-assisted surgical navigation has improved, significant issues still require refinement, including the need to improve methods of head position registration and the ability to update information intraoperatively. Real-time intraoperative imaging using either CT or MRI, although expensive, has begun to develop a foothold in neurosurgery and may become increasingly applicable to the field of otolaryngology. Computer-assisted surgical navigation will also continue to advance with improvements in accuracy, soft tissue imaging, registration and calibration, and the instruments used. In the same way that the bony confines of the sinuses made sinus surgery a particularly good application for computer-assisted surgery, these rigid anatomic boundaries also make this type of surgery particularly applicable to image-guided robotic surgery. Advancements in computer-assisted surgical navigation could potentially lead to remote surgical diagnosis and therapy, enabling endoscopic sinus surgeons of the future to continue to match the quantum-sized leaps that have been made in the past 2 decades.