Image Guidance in Endoscopic Sinus Surgery

Endoscopic sinus surgery is surgery that is performed using cameras through the nostrils to open up and drain the sinuses. There are no external incisions. Since its inception in the 1980s, it has advanced in leaps and bounds, allowing more extensive surgery with less complications and easier recovery. One of the keys to this advancement has been the use of “image guidance” or computer assisted surgery.

At the beginning of endoscopic sinus surgery, the surgeon will trace the outline of the patients’ face and the computer will align and fuse it with the patient’s sinus CAT scan.   There are two ways that the computer can track where the instruments are during the operation, using magnets or an infrared system. We use the Medtronic Fusion® system at both St. Mary’s and Renown. Once it has been registered, the computer screen will show the surgeon where the tip of the suction or probe is during the operation on the computer screen. This enables the surgeon to confirm his or her location within the sinuses and allow the surgeon to access more complicated structures such as the frontal sinus, the sphenoid sinus and orbital or skull base lesions.

The American Academy of Otolaryngology – Head and Neck Surgery and the American Rhinologic Society endorses the use of image guidance in endoscopic sinus surgery in following situations:

  • Revision sinus surgery.
  • Distorted sinus anatomy of development, postoperative, or traumatic origin.
  • Extensive sino-nasal polyposis.
  • Pathology involving the frontal, posterior ethmoid and sphenoid sinuses.
  • Disease abutting the skull base, orbit, optic nerve or carotid artery.
  • CSF rhinorrhea or conditions where there is a skull base defect.
  • Benign and malignant sino-nasal neoplasms.

Dr. Meier uses this technology commonly, and it enables him to address more disease safely. In the past extensive frontal sinus disease would require an external approach that has increased morbidity, however now with improved visualization, techniques and instrumentation in conjunction with image guidance, Dr. Meier is able to endoscopically treat the majority of frontal sinus disorders without incisions.


Josh Meier, M.D. F.A.R.S.