Image guided surgery of paranasal sinuses and anterior skull base - Five years experience with the InstaTrak®-System

ENT Department, University Medical School, Graz, Austria.
Rhinology (Impact Factor: 3.76). 04/2002; 40(1):1-9.
Source: PubMed


We report on our experience with navigational tools in paranasal sinus and anterior skull base surgery, especially with electromagnetic guidance systems. During the last five years we operated over 80 selected cases with the InstaTrak system from VTI (Lawrence, MS, USA). Applicability and user friendliness were explored. The InstaTrak 3500 employs a Sun Workstation and is a frameless and free-arm and navigation system. Two different suction devices, used as sensors (receivers), and one transmitter are interconnected to this workstation. The position of the tip of the aspirator is displayed as a pair of crosshairs on the screen in axial, coronal and sagittal planes of the patient's CT-scan on the computerscreen online. Our results showed high accuracy-level, usually better than one millimeter and a setup-time less than ten minutes, on average. No additional personnel is required in the OR. We believe that the system enhances efficacy in selected cases like revision surgery, tumor surgery or difficult anterior skull base surgery. However, one should consider that medicolegal responsibility stays always with the surgeon and not with any navigation system.

Download full-text


Available from: Heinz Stammberger, Apr 21, 2014
1 Follower
84 Reads
  • Source
    • "Other studies did not include a control group and a comparison to conventional ENT surgery was missing. Among the advantages of EM navigation, the authors listed accurate structure localization during the intervention [78], [184] and fast setup time[41]. As drawbacks, high costs and thus low availability of such systems were reported [184]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Object tracking is a key enabling technology in the context of computer-assisted medical interventions. Allowing the continuous localization of medical instruments and patient anatomy, it is a prerequisite for providing instrument guidance to subsurface anatomical structures. The only widely used technique that enables real-time tracking of small objects without lineof- sight restrictions is electromagnetic (EM) tracking. While EM tracking has been the subject of many research efforts, clinical applications have been slow to emerge. The aim of this review paper is therefore to provide insight into the future potential and limitations of EM tracking for medical use. We describe the basic working principles of EM tracking systems, list the main sources of error, and summarize the published studies on tracking accuracy, precision and robustness along with the corresponding validation protocols proposed. State-of-the-art approaches to error compensation are also reviewed in depth. Finally, an overview of the clinical applications addressed with EM tracking is given. Throughout the paper, we report not only on scientific progress, but also provide a review on commercial systems. Given the continuous debate on the applicability of EM tracking in medicine, this paper provides a timely overview of the state-of-the-art in the field.
    IEEE Transactions on Medical Imaging 05/2014; DOI:10.1109/TMI.2014.2321777 · 3.39 Impact Factor
  • Source
    • "The position of electromagnetic navigation is measured by detecting of magnetic field changes with coils [19,21,29]. The electromagnetic transmitter is located near the operative site and the receiver is inside the surgical instrument. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Surgery in the cranial area includes complex anatomic situations with high-risk structures and high demands for functional and aesthetic results. Conventional surgery requires that the surgeon transfers complex anatomic and surgical planning information, using spatial sense and experience. The surgical procedure depends entirely on the manual skills of the operator. The development of image-guided surgery provides new revolutionary opportunities by integrating presurgical 3D imaging and intraoperative manipulation. Augmented reality, mechatronic surgical tools, and medical robotics may continue to progress in surgical instrumentation, and ultimately, surgical care. The aim of this article is to review and discuss state-of-the-art surgical navigation and medical robotics, image-to-patient registration, aspects of accuracy, and clinical applications for surgery in the cranial area.
    Biomedical Imaging and Intervention Journal 01/2007; 3(1):e11. DOI:10.2349/biij.3.1.e11
  • Source
    • "We concur with other authors that navigational systems are extremely helpful in revision surgery particularly of the frontal sinus, in the proximity of relevant anatomical regions (i.e. orbital cavity, optic nerve, cavernous sinus, internal carotid artery), and in selected tumor cases [36]. It is mandatory to follow patients surgically treated for FD with serial MR every 6 months during the first year after surgery and at yearly intervals thereafter. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Fibrous dysplasia (FD) is a non-neoplastic, expansile lesion of unknown origin. In about one-fourth of cases this disorder affects the head and neck area, where the mandible and maxilla are the most frequently involved sites. Its localization to the ethmoid is a rare event. Since the disease slowly progresses, its management is delayed until significant clinical symptoms or non-well-tolerated aesthetic deformities are present. When required, surgery is the treatment of choice. Several external procedures have been used to manage the lesion, but recently, more conservative transnasal approaches have been proposed. We report the history of a 6-year-old boy with fibrous dysplasia of the ethmoid labyrinth that underwent successful transnasal endoscopic removal. Furthermore, an analysis of the literature is presented with particular emphasis on clinical picture, diagnosis, and treatment of this rare illness.
    International Journal of Pediatric Otorhinolaryngology 02/2005; 69(1):43-8. DOI:10.1016/j.ijporl.2004.07.017 · 1.19 Impact Factor
Show more