Electromagnetic navigation systems using surface registration are a suitable adjuvant tool for ESS. It takes less than 4 minutes to complete the equipment set-up and surface registration, and it offers invaluable real-time information on location with sufficient accuracy. In the three-dimensional analysis of surface registration accuracy, the deviations in the ML direction are significantly less than those for the other two axes.
Regarding comparisons of the optic and electromagnetic navigation systems, the electromagnetic navigation system takes significantly less time to complete the surface registration than the optic navigation system. The time for registration in both systems only accounts for less than 2% of the time taken for the surgery on one side.
Furthermore, the accuracy of the two navigation systems is acceptable and comparable in clinical use. In other words, the electromagnetic navigation system is as accurate as the optic navigation system using the surface registration technique under clinical condition. However, we recommend using the electromagnetic navigation in CAS because of the advantage provided by continuous tracking without interruption, especially in cluttered operation theatres. In the three-dimensional analysis of the two-system accuracy, the best accuracy was also measured in the ML direction compared with the other two axes, either in optic or electromagnetic navigation tracking.
This finding suggests that surgeons should be more cautious when dissecting in the AP or CC direction during the course of navigation for sinus surgery.
References
1. Ecke U, Luebben B, Maurer J, Boor S, Mann WJ. Comparison of Different Computer-Aided Surgery Systems in Skull Base Surgery. Skull Base. 2003; 13:
43-50.
2. Kennedy DW, Zinreich SJ, Rosenbaum AE, Johns ME. Functional endoscopic sinus surgery. Theory and diagnostic evaluation. Arch Otolaryngol. 1985; 111:
576-582.
3. Schloendorff G, Moesges R, Meyer-Ebrecht D, Krybus W, Adams L. CAS (computer assisted surgery). A new procedure in head and neck surgery. HNO.
1989; 37: 187-190.
4. Anon JB. Computer-aided endoscopic sinus surgery. Laryngoscope. 1998; 108:
949-961.
5. Mafee MF, Chow JM, Meyers R. Functional endoscopic sinus surgery: anatomy, CT screening, indications, and complications. AJR Am J Roentgenol. 1993; 160:
735-744.
6. Hepworth EJ, Bucknor M, Patel A, Vaughan WC. Nationwide survey on the use of image-guided functional endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2006; 135: 68-73.
7. Al-Swiahb JN, Al Dousary SH. Computer-aided endoscopic sinus surgery: a retrospective comparative study. Ann Saudi Med 2010; 30: 149-152.
8. Fried MP, Topulos G, Hsu L, et al. Endoscopic sinus surgery with magnetic resonance imaging guidance: initial patient experience. Otolaryngol Head Neck Surg. 1998; 119: 374-380.
9. Mosges R1, Schlondorff G. A new imaging method for intraoperative therapy control in skull-base surgery. Neurosurg Rev. 1988; 11: 245-247.
doi:10.6342/NTU201701967
34
10. Reinhardt HF, Horstmann GA, Gratzl O. Microsurgical removal of deep vascular malformations using sonar-stereometry. Ultraschall Med. 1991; 12: 80-83.
11. Claes J, Koekelkoren E, Wuyts FL, Claes GM, Van den Hauwe L, Van de Heyning PH. Accuracy of computer navigation in ear, nose, throat surgery: the influence of matching strategy. Arch Otolaryngol Head Neck Surg. 2000; 126:
1462-1466.
12. Eliashar R, Sichel JY, Gross M, et al. Image guided navigation system-a new technology for complex endoscopic endonasal surgery. Postgrad Med J. 2003; 79:
686-690.
13. Metson RB. Image-guided sinus surgery: Lessons learnt from the first 1000 cases. Otolaryngol Head Neck Surg. 2003; 128: 8-13.
14. Metson RB, Cosenza MJ, Cunningham MJ, Randolph GW. Physician experience with an optical image guidance system for sinus surgery. Laryngoscope. 2000;
110: 972-976.
15. Snyderman C1, Zimmer LA, Kassam A. Sources of registration error with image guidance systems during endoscopic anterior cranial base surgery. Otolaryngol Head Neck Surg. 2004; 131: 145-149.
16. Klimek L, Ecke U, Lubben B, Witte J, Mann W. A passive-marker-based optical system for computer-aided surgery in otorhinolaryngology: development and first clinical experiences. Laryngoscope. 1999; 109: 1509-1515.
17. Hummel J, Figl M, Birkfellner W, et al. Evaluation of a new electromagnetic tracking system using a standardized assessment protocol. Phys Med Biol. 2006;
51: N205-210.
18. Yaniv Z, Wilson E, Lindisch D, Cleary K. Electromagnetic tracking in the clinical environment. Med Phys. 2009; 36: 876-892.
19. Fried MP, Kleefield J, Gopal H, Reardon E, Ho BT, Kuhn FA. Image-guided endoscopic surgery: results of accuracy and performance in a multicenter clinical study using an electromagnetic tracking system. Laryngoscope. 1997; 107:
594-601.
20. Maurer CR Jr, Fitzpatrick JM, Wang MY, Galloway RL Jr, Maciunas RJ, Allen GS. Registration of head volume images using implantable fiducial markers.
IEEE Trans Med Imaging. 1997; 16: 447-462.
21. Maurer CR Jr, Maciunas RJ, Fitzpatrick JM. Registration of head CT images to physical space using a weighted combination of points and surfaces. IEEE Trans Med Imaging. 1998; 17: 753-761.
22. Raabe A, Krishnan R, Wolff R, Hermann E, Zimmermann M, Seifert V. Laser surface scanning for patient registration in intracranial image-guided surgery.
Neurosurgery. 2002; 50: 797-803.
23. Schlaier J, Warnat J, Brawanski A. Registration accuracy and practicability of laser-directed surface matching. Comput Aided Surg 2002; 7: 284-290.
24. Stelter K, Andratschke M, Leunig A, Hagedorn H. Computer-assisted surgery of the paranasal sinuses: technical and clinical experience with 368 patients, using the Vector Vision Compact system. J Laryngol Otol. 2006; 120: 1026-32.
25. Ledderose GJ, Stelter K, Leunig A, Hagedorn H. Surface laser registration in ENT-surgery: accuracy in the paranasal sinuses--a cadaveric study. Rhinology.
2007; 45: 281-285.
26. Kral F, Puschban EJ, Riechelmann H, Pedross F, Freysinger W. Optical and electromagnetic tracking for navigated surgery of the sinuses and frontal skull base. Rhinology 2011; 49: 364-368.
27. Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: Developing guidance
doi:10.6342/NTU201701967
36
for clinical trials. Otolaryngol Head Neck Surg. 2006; 135: S31-80.
28. Fitzpatrick JM, West JB, Maurer CR Jr. Predicting error in rigid-body point-based registration. IEEE Trans Med Imaging. 1997; 17: 694-702.
29. Labadie RF, Davis BM, Fitzpatrick JM. Image-guided surgery: what is the accuracy? Curr Opin Otolaryngol Head Neck Surg. 2005; 13: 27-31.
30. May M, Levine HL, Mester SJ, Schaitkin B. Complications of endoscopic sinus surgery: analysis of 2108 patients--incidence and prevention. Laryngoscope.
1994; 104: 1080-1083.
31. Tschopp KP, Thomaser EG. Outcome of functional endonasal sinus surgery with and without CT-navigation. Rhinology. 2008; 46: 116-120.
32. Metson R, Gliklich RE, Cosenza M. A comparison of image guidance systems for sinus surgery. Laryngoscope. 1998; 108: 1164-1170.
33. Grevers G, Menauer F, Leunig A, Caversaccio M, Kastenbauer E. Navigation surgery in diseases of the paranasal sinuses. Laryngorhinootologie. 1999; 78:
41-46.
34. Schmerber S, Chassat F. Accuracy evaluation of a CAS system: laboratory protocol and results with 6D localizers, and clinical experiences in otorhinolaryngology. Comput Aided Surg. 2001; 6: 1-13.
35. Knott PD, Batra PS, Butler RS, Citardi MJ. Contour and paired-point registration in a model for image-guided surgery. Laryngoscope. 2006; 116:
1877-1881.
36. Roth M, Lanza DC, Zinreich J, Yousem D, Scanlan KA, Kennedy DW.
Advantages and disadvantages of three-dimensional computed tomography intraoperative localization for functional endoscopic sinus surgery.
Laryngoscope. 1995; 105: 1279-1286.
37. Stelter K, Ertl-Wagner B, Luz M, et al. Evaluation of an image-guided navigation system in the training of functional endoscopic sinus surgeons. A prospective, randomised clinical study. Rhinology. 2011; 49: 429-437.
doi:10.6342/NTU201701967
38
Appendix
Publication List of Chih-Ming Chang (SCI):
1. Chang CM, Young YH, Jaw FS, Wang CT, Cheng PW (2017). Degeneration of the vestibular nerve in unilateral Meniere’s disease evaluated by galvanic vestibular-evoked myogenic potentials. (In press)
2. Chang CM, Jaw FS, Lo WC, Fang KM, Cheng PW (2016). Three-dimensional analysis of the accuracy of optic and electromagnetic navigation systems using surface
registration in live endoscopic sinus surgery. Rhinology 54: 88-94.
3. Lo WC, Chang CM, Liao LJ, Wang CT, Young YH, Chang YL, Cheng PW (2015).
Assessment of d-methionine protecting cisplatin-induced otolith toxicity by
vestibular-evoked myogenic potential tests, ATPase activities and oxidative state in guinea pigs. Neurotoxicol Teratol 51: 12-20.
4. Sung PH, Chang CM, Young YH, Jaw FS, Cheng PW (2014). Optimal stimulation mode for obtaining galvanic ocular vestibular-evoked myogenic potentials. Clin Otolaryngol. 39: 240-245.
5. Chang CM, Young YH, Cheng PW (2013). Feasibility of simultaneous recording of cervical and ocular vestibular-evoked myogenic potentials via galvanic vestibular stimulation. Acta Otolaryngol. 133: 1278-1284.
6. Chang CM, Fang KM, Huang TW, Wang CT, Cheng PW (2013). Three-dimensional analysis of the surface registration accuracy of electromagnetic navigation systems in live endoscopic sinus surgery. Rhinology 51: 343-348.
7. Chang CM, Young YH, Cheng PW (2012). Age-related Changes in Ocular Vestibular-Evoked Myogenic Potentials via Galvanic Vestibular Stimulation and Bone-conducted Vibration Modes. Acta Otolaryngol 132: 1295-1300.
8. Chang CM, Cheng PW, Wang SJ, Young YH (2010). Effects of repetition rate of bone-conducted vibration on ocular and cervical vestibular-evoked myogenic potentials.
Clin Neurophysiol 121: 2121-2127.
9. Chang CM, Cheng PW, Young YH (2010). Aging effect on galvanic vestibular-evoked myogenic potentials. Otolaryngol Head Neck Surg 143: 418-421.