Passive marker computer-aided sinonasal and cranial base surgery: observations from a learning curve

Area of Science:

• Neurosurgery
• Otolaryngology
• Medical Technology

Background:

• Computer-aided surgery (CAS) enhances precision in complex head and neck procedures.
• Passive marker systems offer potential advantages in instrument flexibility and intraoperative adaptability.
• Evaluating the clinical feasibility and accuracy of passive marker CAS in sinonasal and cranial base surgery is crucial.

Purpose of the Study:

• To assess the feasibility and accuracy of passive marker computer-aided surgery (CAS) in a single institution.
• To evaluate the utility of CAS in various sinonasal and cranial base pathologies.

Main Methods:

• Twenty-two procedures were performed on 21 patients with conditions including sinonasal tumors, fungal sinusitis, polyps, chronic sinusitis, and cerebrospinal fluid leaks.
• Passive marker CAS was utilized, with instrument conversion, rotation, and cordlessness features assessed.
• Accuracy was measured, and the system's assistance with anatomical landmarks, margins, skull base, orbit, and surgical approach was recorded.

Main Results:

• Passive marker CAS was successful in 19 out of 21 patients (90.5% success rate).
• The system demonstrated high accuracy, with measurements on the order of 1.35 mm.
• CAS provided significant assistance with identifying landmarks (14 cases), margins (7 cases), skull base (6 cases), orbit (5 cases), and surgical approach (4 cases).

Conclusions:

• Passive marker computer-aided surgery is a feasible and accurate navigation technology for sinonasal and cranial base procedures.
• The system's ability to convert instruments into cordless imaging probes on demand offers significant intraoperative advantages.
• CAS aids surgeons in defining critical anatomical structures, tumor margins, and optimizing surgical approaches in complex cases.