Clinical utility of intraoperative volume computed tomography scanner for endoscopic sinonasal and skull base procedures

Background: Intraoperative surgical navigation has become widely accepted as an important tool for improvement of surgical outcomes and reduction of complication in endoscopic sinus surgery (ESS). The purpose of this study was to assess the clinical utility of intraoperative volume computed tomography (CT) scanning in endoscopic sinonasal and skull base procedures. Methods: Retrospective review of patients who underwent intraoperative volume CT imaging (xCAT; XoranTechnologies, Ann Arbor, MI) during endoscopic sinonasal and skull base surgery during a 3-month period was performed. Intraoperative, computer-enabled triplanar review of reformatted 0.4-mm images was performed in all cases. Results: Intraoperative volume CT scanning was completed in 25 patients. Surgical procedures included revision/primary ESS for chronic rhinosinusitis (CRS) with or without polyposis (12 cases) and mucoceles (6 cases) as well as endoscopic neoplasm resection (5 cases), endoscopic fibro-osseous lesion resection (1 case), and endoscopic meningoencephalocele repair (1 case). The indications for intraoperative CT scanning included assessment of surgical dissection (23 cases), extent of tumor resection (6 cases), and frontal stent placement (6 cases). Based on the intraoperative volume CT information, additional interventions, including additional tumor resection (2 cases), dissection of ethmoid partitions (2 cases), frontal bone drilling during Draf IIB (1 case), and repositioning of a frontal stent (1 case) were performed in 6 (24%) cases. Conclusion: Intraoperative volume CT scanning was successfully performed in 25 patients undergoing ESS. Because additional surgical intervention was performed in 24% of cases, this technology may have an important role in endoscopic sinonasal and skull base procedures.