Image-guided resection of fibro-osseous lesions of the skull base

Endoscopic resection of sinonasal fibro-osseous lesions remains a technical challenge because of the loss of anatomic landmarks and the frequent need to resect bone along the skull base. The purpose of this study was to evaluate the usefulness of image-guidance systems for the resection of these lesions.

Endoscopic surgery was performed in 10 patients with fibro-osseous lesions of the sinuses and skull base (six fibrous dysplasias and four osteomas). Indications for surgical intervention were recurrent infection (7), facial pain (3), mucocele (1), and compressive optic neuropathy (1). All surgeries were performed with an image-guidance system, which included an integrated high-speed drill system.

Anatomic localization was accurate to within 1 mm when monitoring the depth of bone removal along the skull base. Complete resection of the fibro-osseous lesion was possible in six patients (60%) and partial removal was possible in four patients (40%). In the latter group, a margin of dysplastic bone was preserved along the ethmoid roof to prevent dural exposure. There were no intraoperative complications. Surgery resulted in resolution of infection and facial pain in nine patients (90%). Additional surgery was required in one patient (10%) who developed recurrent optic neuropathy because of continued dysplastic bone growth. Mean follow-up was 34 months (range, 13-67 months).

Image-guidance technology appears to be ideally suited for the treatment of patients with fibro-osseous lesions of the sinonasal cavity. Real-time monitoring of the depth of bone removal relative to the skull base may enhance the safety and efficacy of such surgery.