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Image guidance systems for minimally invasive sinus and skull base surgery in children
Margo McKenna Benoit1, V Michelle Silvera, Richard Nichollas
1Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, 243 Charles Street, Boston, MA 02114, USA. Margo_Benoit@meei.harvard.edu
Insights
Image guidance systems are safe and effective for pediatric sinonasal and skull base surgery. Surgeon satisfaction and accuracy improved with experience, facilitating minimally invasive endoscopic approaches.
Area of Science:
- Otolaryngology
- Neurosurgery
- Pediatric Surgery
Background:
- Image guidance systems (IGS) are established in adult sinonasal and skull base surgery.
- Limited data exists on IGS use in pediatric populations for these procedures.
Purpose of the Study:
- To evaluate the efficacy and safety of IGS in pediatric endoscopic sinonasal and skull base surgery.
- To assess the impact of IGS on surgical outcomes and surgeon experience in children.
Main Methods:
- Retrospective cohort study of 33 pediatric patients undergoing endoscopic surgery with IGS.
- Data collected included diagnoses, disease extent, surgical variables (set-up time, accuracy, satisfaction), and complications.
- Surgical indications included sinusitis complications, neoplasms, choanal atresia, and cerebrospinal fluid leaks.
Main Results:
- IGS was used in 28 sinonasal and 5 skull base surgeries.
- No surgical complications were reported; 94% required a single procedure.
- Surgeon satisfaction, accuracy, and usage frequency increased significantly over time (p<0.05).
Conclusions:
- IGS is a safe and effective tool for pediatric minimally invasive sinonasal and skull base surgery.
- Increased experience with IGS correlates with improved surgeon comfort and procedural accuracy.
- IGS enhances anatomical visualization, supporting minimally invasive endoscopic treatment of pediatric sinonasal and skull base pathologies.
Objective:
The use of image guidance for sinonasal and skull base surgery has been well-characterized in adults but there is limited information on the use of these systems in the pediatric population, despite their widespread use. The aim of this study is to evaluate the use of image guidance systems to facilitate an endoscopic minimally invasive approach to sinonasal and skull base surgery in a pediatric population.
Methods:
A retrospective cohort study was performed at a tertiary pediatric hospital. Thirty-three children presented with complications of sinusitis, tumors, traumatic, or congenital lesions of the skull base and underwent endoscopic surgery using image guidance from March 2000 to April 2007. Patient variables including diagnosis, extent of disease, and complications were extracted from paper and computer charts. Additional surgical variables including set-up time, accuracy, surgeon satisfaction index and number of uses per case were also reviewed.
Results:
Twenty-eight patients (85%) underwent sinonasal surgery and five (15%) underwent skull base surgery. Indications included infectious complications of acute sinusitis (N=15), neoplasms (N=12), choanal atresia (N=4), and cerebrospinal fluid leak (N=2). Thirty-one patients (94%) required only one procedure. No surgical complications were reported. Surgeon satisfaction, mean accuracy and number of uses per procedure increased over time (p<0.05).
Conclusions:
Image guidance systems are safe and effective tools that facilitate a minimally invasive approach to sinonasal and skull base surgery in children. Consistent with adult literature, usage and surgeon comfort increased with experience. The additional anatomical information obtained by image guidance systems facilitates a minimally invasive endoscopic approach for sinonasal and skull base pathologies.
