Image Guided Endoscopic Sinus Surgery: First Experience from Kashmir Valley

Area of Science:

• Otolaryngology
• Neurosurgery
• Medical Imaging

Background:

• Paranasal sinus surgeries require high anatomical precision due to proximity to critical structures like the orbit and cranial cavity.
• Anatomical variations in patients can present challenges during traditional endoscopic sinus surgery.
• Image guidance systems offer enhanced visualization and accuracy in complex surgical procedures.

Purpose of the Study:

• To report the initial experience with image-guided endoscopic sinus surgery (IGESS) in the Kashmir valley.
• To evaluate the real-time correlation between the operative field and preoperative imaging during IGESS.
• To assess the utility of IGESS in achieving complete disease clearance and improving patient-reported outcomes.

Main Methods:

• A prospective observational study involving 20 patients undergoing IGESS from September 2016 to August 2018.
• Preoperative and postoperative assessment using Visual Analog Scale (VAS), Sino-Nasal Outcome Test-22 (SNOT-22), and Lund-Mackay scores (endoscopic and radiological).
• Data collection included operative time, instrument accuracy, setup time, blood loss, and complications.

Main Results:

• A statistically significant reduction in postoperative VAS, SNOT-22, and Lund-Mackay scores was observed.
• The average accuracy of the navigation system was 1.25 ± 0.73 mm, with an average blood loss of 100 ± 23.54 ml.
• Revision FESS was performed in 12 cases, with the middle turbinate frequently absent as an intraoperative landmark. No major orbital or intracranial complications occurred.

Conclusions:

• Image-guided surgery is a valuable tool for paranasal sinus surgeries, particularly in difficult and revision cases.
• IGESS enhances surgeon confidence and potentially reduces the risk of major complications.
• The study demonstrates the successful implementation and positive outcomes of IGESS in a new geographical region.