Der Einfluss der Navigation auf die endoskopische NNH-Chirurgie

The application of surgical procedure manager (SPM): first experience with FESS

In our hypothesis, the newly developed program SPM (surgical procedure manager) will ensure successful standardization and efficiency of the FESS (functional endoscopic sinus surgery) and therefore make a decisive contribution in terms of economization and improvement of intraoperative quality. Between 27th March 2015 and 8th October 2015, data from 259 FESS procedures were collected using the SPM. The study took place at the surgical desk, an operating room in the ACQUA clinic in Leipzig, Germany. 233 FESS (90%) of the total FESS (n = 259, 100%) were conducted entirely with SPM. 26 SPM terminations (10%) of 259 FESS remain, which are classified as actual SPM terminations-when the surgeon intentionally stops the SPM. The maximum time slot decreased clearly from 1 h 39 min (period A) to 1 h 10 min (period B). A time reduction can also be seen with the minimum duration of 13.5 min compared to 11 min. The variability of the time slot also decreases since the standard deviation is reduced by 4.5 min. On the basis of available recordings it can be postulated that the application of SPM is suitable for standardization for FESS. Standardization by means of SPM and minimal development can be recognized over a period of time. The SPM makes it possible to transfer the general advantages of mechanization on a concrete FESS and do not influence the medical processes nor even restrict the medical freedom. The users are still entirely free in the implementation of the respective procedure.

[12 years of Computer-Aided Surgery around the Head : Developments in surgical planning and simulation from a Bern perspective]

Over the past years, the multidisciplinary character of the international Computer-Aided Surgery around the Head (CAS-H) symposium has advanced many medical technologies, which were often adopted by industry. In Bern, the synergetic effects of the CAS-H symposium have enabled many experiences and developments in the area of computer-aided surgery. Planning and simulation methods in the areas of craniomaxillofacial surgery and otorhinolaryngology were developed and tested in clinical settings. In the future, further CAS-H symposia should follow, in order to promote the possibilities and applications of computer-assisted surgery around the head.

Safe and rapid contouring of fibro-osseous lesions in the orbital area using navigation with minimally invasive cranial bone registration

BACKGROUND

Bone contouring is currently the best treatment for fibro-osseous lesions after bone growth arrest. Navigation systems available for this surgery allow intra-operative visualisation with improved cosmetic outcomes. However, conventional navigation systems using superficial skin registration cannot prevent subtle discrepancies.

METHOD

To address this problem, we used a non-invasive cranial bone registration that uses patient-specific dental templates to maintain exact registration. We created the preset goal using the mirror image of the unaffected side for unilateral lesions, and using images obtained before the onset of symptoms for bilateral lesions. This system achieved precise pre-operative simulation. A sound aid in the navigation system provided information regarding proximity to critical structures and to the preset goal.

RESULTS

We used this system to contour fibro-osseous lesions in three patients. All patients achieved good facial contours and improvement in symptoms.

CONCLUSIONS

This method offers a safe, rapid surgical aid in treating orbital fibro-osseous lesions.

Skull base inverted papilloma: a comprehensive review

Skull base inverted papilloma (IP) is an unusual entity for many neurosurgeons. IP is renowned for its high rate of recurrence, its ability to cause local destruction, and its association with malignancy. This paper is a comprehensive review of the reports, studies, and reviews published in the current biomedical literature from 1947 to September 2010 and synthesize this information to focus on its potential invasion to the base of the skull and possible intradural extension. The objective is to familiarize the clinician with the different aspects of this unusual disease. The role of modern diagnostic tools in medical imaging in order to assess clearly the limits of the tumors and to enhance the efficiency and the safety in the choice of a surgical approach is pointed out. The treatment guidelines for IP have undergone a complex evolution that continues today. Radical excision of the tumour is technically difficult and often incomplete. Successful management of IP requires resection of the affected mucosa which could be achieved with open surgery, endoscopic, or combined approach. Radio and chemotherapy were used for certain indications. More optimally research would be a multicenter randomized trials with large size cohorts.

Sinus mucocele: natural history and long-term recurrence rate

OBJECTIVE

To define the natural history, clinical signs, treatment and the modalities of medium- and long-term follow-up of patients operated for sinus mucocele.

PATIENTS AND METHOD

Retrospective study of all patients operated for sinus mucocele between January 1993 and December 2009 (n=68). Demographic data, symptoms, medical imaging findings, surgical treatment and results were recorded.

RESULTS

The mean age of patients in this series was 53 years (range: 27-82 years, sex ratio: 3/2). The most common site was fronto-ethmoidal. Fifty-one patients (75%) had a history of sinus surgery, essentially for nasal polyposis. Only 15% of mucoceles occurred spontaneously. Presenting symptoms, in decreasing order of frequency, were facial pain or headache (38%), ocular or orbital complications (28%), while 20% of patients were asymptomatic. Surgery was performed by endonasal endoscopic sinus surgery (n=57, 84%) or via a combined, transfacial and endonasal approach, associated with navigation after January 2003. The mean follow-up was 7 years (range: 4 months-16 years). During this follow-up period, 23.5% of patients developed recurrence or a second mucocele after a mean interval of 4 years.

CONCLUSION

This study demonstrates the high recurrence rate of mucocele, particularly in multi-operated patients with chronic sinusitis. Long-term, regular, clinical and radiological follow-up is necessary to detect asymptomatic lesions prior to the onset of complications.

[Update: catheter-based balloon dilatation of the sinuses without fluoroscopy. Dilation technique with an illumination system]

BACKGROUND

Catheter-based balloon dilation of the sinus ostia follows the general guidelines for functional endoscopic sinus surgery with the goal of reopening the sinus ostium to restore ventilation and drainage of the sinus and reestablish normal mucosal function, while maintaining normal mucosal tissue and avoiding scar tissue formation. A main criticism of this procedure questions the necessity of fluoroscopy with the C-arm since its use exposes patients and medical personnel to radiation and the C-arm is not available in every ENT operating room.

MATERIAL AND METHODS

Catheter-based balloon dilation of the sinus ostia was performed with the Relieva Luma Sinus Illumination System (Acclarent, Inc.) without fluoroscopy.

RESULTS

Using this method of illumination, it was possible to localize the device tip transcutaneously in the maxillary and frontal sinus cavities, making radiological exposure unnecessary.

CONCLUSION

The advantages of catheter-based balloon dilation without fluoroscopy lie in the elimination of radiation exposure to the patient and personnel as well as the cost savings. Randomized controlled trials should be planned to further evaluate this technique.