Computer Image Guided Sinus Surgery

By: Timothy L. Smith, MD, MPH, FACS

Professor and Director, Oregon Sinus Center

Lindsay Wyant, M.S., PA-C

Instructor, Oregon Sinus Center

 Computer Image Guided Sinus Surgery

The Oregon Sinus Center at OHSU offers an array of new surgical technologies for the treatment of sinusitis. One of the most recent advances is the development of computer-guided sinus surgery. Via a computer workstation in the operating room, surgeons can now access 3-dimensional CT scan images of a patient's sinuses during surgery. This interactive surgical device allows identification of critical anatomic structures and treatment of diseased areas for the patient with complex sinus disease.

The Oregon Sinus Center surgeons are using this new "STEALTH" technology that guides surgical instruments for potentially more accurate and effective sinus surgery. Because the new procedure is done through an endoscope inserted into the nose, an open incision is rarely necessary. 

The new technology, image-guided surgery, is used during surgery for severe forms of chronic sinusitis, in cases when previous sinus surgery has altered anatomical landmarks, or where a patient's sinus anatomy is very unusual, making typical surgery difficult. Tumors and cerebrospinal fluid leaks involving the nose and sinuses may also be approached using this technology. 

While complications of sinus surgery are very low, unusual nasal structures may put a patient at increased risk for complication. The guided surgery system may help to minimize such risks. 

The patient population at the Oregon Sinus Center tends to have severe sinusitis and many have gone through previous sinus surgeries that were not as successful as they had hoped. The image guidance system is utilized in most of these sinus surgeries that are performed by the sinus specialists.

Image guidance is a near-three-dimensional mapping system that combines computed tomography (CT) scans and real-time information about the exact position of surgical instruments using infrared signals. In this way, surgeons can navigate their way through complex sinus passages and provide surgical relief more precisely. Image guidance uses some of the same stealth principles used by the military.

Prior to surgery, an endoscope is used to examine nasal and sinus passages, and CT scans are taken to build a computerized model of the patient's skull. During surgery, the surgeon views a computer monitor where the image guidance system shows the location of the surgical instrument's tip on the CT scans. Tissue that is obstructing the sinuses is surgically removed so that sinuses can drain properly.

Almost all patients go home shortly after surgery and without gauze packing in their noses. The surgical precision of the image guidance system means that less tissue is damaged, so recovery is faster and there is less discomfort than in surgeries that previously required open incisions.

Patient's Problems Relieved

One patient struggled through ten years of chronic sinusitis and three sinus surgeries before turning to Dr. Timothy Smith for help. She felt a lot of people had given up on her. 

She had been on antibiotics constantly, nearly every month with two weeks on, two weeks off. The strength of the antibiotics was constantly increased. She explained how the use of antibiotics affected her joints. 

Her right frontal sinus closed off and nothing would drain. After a while, a membrane grew in the opening, trapping the mucus and causing severe eye pain. Finally, she had 100% blockage that was so close to the brain and eyes, that it was imperative she have surgery. 

The surgeon explained that opening the membrane could be difficult due to the small space, and because of it being so close to the brain and eyes. The image-guided surgery system has been particularly helpful in these situations.

The patient went through the surgery with a normal healing process and no complications. She has been much healthier since this surgery.

See the selected publications to review ongoing research into this type of surgery by surgeons at the Oregon Sinus Center.