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Use of real-time magnetic resonance image guidance in endoscopic sinus surgery
1Department of Otolaryngology, Shiga University of Medical Science, Seta, Otsu, Japan.
Abstract:
We evaluated the effectiveness of magnetic resonance image (MRI) guidance using an optical tracking system (MRI-guided therapy: MRT) in performing endoscopic sinus surgery (ESS). The profiles of the fourteen patients in the present study were as follows: eleven with mucocele in the paranasal sinus, one with recurrent chronic sinusitis, one with maxillary cancer, and one with Graves' ophthalmopathy. Preparation of the MRT system required an additional 54 min in cases involving general anesthesia, and an additional 17 min in cases involving local anesthesia, in comparison with corresponding control groups undergoing ESS in a traditional operating room. We developed nonmetal probes that were visualized in a real-time mode and assistive devices for the optical tracking system that were equipped to avoid obstruction caused by surgical instruments as well as by the hands of surgeons. Using these unique devices, anatomic landmarks were visualized using the present MRT system. The prognosis of patients was favorable, and in particular, no patients with sinus mucocele showed a recurrence of their lesions. We concluded that the MRT system used here for performing ESS was beneficial, especially in terms of the intranasal marsupialization of sinus mucoceles and for the verification of orbital contents.
Insights
Magnetic resonance image-guided therapy (MRT) enhances endoscopic sinus surgery (ESS) accuracy, particularly for sinus mucoceles and orbital content verification. This advanced technique shows favorable patient outcomes with no recurrence observed in mucocele cases.
Area of Science:
- Otolaryngology
- Medical Imaging
- Surgical Technology
Background:
- Endoscopic sinus surgery (ESS) is a common procedure for various sinonasal conditions.
- Limitations in traditional ESS include challenges in precise navigation and visualization of critical anatomical structures.
- Magnetic resonance imaging (MRI) offers detailed soft-tissue contrast, but its integration into real-time surgical guidance has been limited.
Purpose of the Study:
- To evaluate the effectiveness of a novel MRI-guided therapy (MRT) system for enhancing endoscopic sinus surgery (ESS).
- To assess the feasibility and benefits of MRT in specific sinonasal pathologies, including mucoceles, chronic sinusitis, cancer, and Graves' ophthalmopathy.
- To introduce innovative nonmetal probes and assistive devices designed for real-time visualization and instrument tracking within the MRT system.
Main Methods:
- Development and implementation of an MRI-guided therapy (MRT) system incorporating an optical tracking system.
- Creation of nonmetal probes for real-time visualization and assistive devices to prevent surgical instrument obstruction.
- Application of the MRT system in fourteen patients undergoing ESS for various sinonasal conditions.
- Comparison of procedure times with traditional ESS in control groups under general and local anesthesia.
Main Results:
- The MRT system successfully visualized anatomic landmarks in real-time during ESS.
- Preparation time for the MRT system added 54 minutes for general anesthesia and 17 minutes for local anesthesia cases compared to standard ESS.
- Patient prognosis was favorable, with a notable absence of recurrence in patients with sinus mucoceles.
- The system proved particularly beneficial for intranasal marsupialization of sinus mucoceles and verification of orbital contents.
Conclusions:
- The developed MRI-guided therapy (MRT) system is beneficial for performing endoscopic sinus surgery (ESS).
- MRT offers significant advantages in managing complex cases, such as intranasal marsupialization of sinus mucoceles.
- The system aids in precise verification of orbital contents, potentially improving safety and outcomes in ESS.
