Can Virtual Endoscopy Improve Surgical Planning in the Frontal Recess?
Virtual endoscopy (VE) has the potential to help both novice and expert rhinologists overcome the technical challenges presented during surgical dissection of the frontal sinus and frontal recess. As a planning tool, high-quality VE could provide benefits in surgical efficiency and safety, especially in academic medical school training environments such as the Department of Otorhinolaryngology at McGovern Medical School at UTHealth Houston.
“Virtual endoscopy uses high-resolution CT scans to create a simulated fly-through of a hollow body organ, which makes it useful in examining paranasal sinus anatomy,” explains Martin Citardi, MD, professor and chair of the department and vice dean for technology at UTHealth Houston. “VE has been around for about 30 years but traditionally it required a very powerful dedicated computer and a technician, who needed several hours to render useful images, which is impractical in the typical clinical environment, which is characterized by high surgical volume. To overcome this problem, we conducted a pilot study using semi-automated, commercially available software that creates – in just a minute or two – VE images of the nasal and sinus space as a potential preoperative planning tool.”
The researchers used the TruDi navigation system from Acclarent to create renderings of a virtual fly-through of the frontal sinus drainage pathway using high-resolution sinus CT imaging data. “About 30 percent of the time, the algorithm could not locate the pathway, but the other 70 percent of the time it found it without any correction,” Dr. Citardi says. “We consider this reasonable reliability, but for accuracy, the surgeon should reconfirm the results with a tri-planar sinus CT scan. Technical enhancements to the system’s VE rendering protocols will likely make this type of visualization even more useful in surgical navigation.”
The research was presented by Ali B. Jafar, MD, rhinology fellow, at the American Rhinologic Society (ARS) meeting held in Boston. William C. Yao, MD, associate professor and director of the department’s residency program, also participated in the study.