title: Image guidance systems for minimally invasive sinus and skull base surgery in children.
abstract: OBJECTIVE
  The use of image guidance for sinonasal and skull base surgery has been well-characterized in adults but there is limited information on the use of these systems in the pediatric population, despite their widespread use. The aim of this study is to evaluate the use of image guidance systems to facilitate an endoscopic minimally invasive approach to sinonasal and skull base surgery in a pediatric population.
  
  
  METHODS
  A retrospective cohort study was performed at a tertiary pediatric hospital. Thirty-three children presented with complications of sinusitis, tumors, traumatic, or congenital lesions of the skull base and underwent endoscopic surgery using image guidance from March 2000 to April 2007. Patient variables including diagnosis, extent of disease, and complications were extracted from paper and computer charts. Additional surgical variables including set-up time, accuracy, surgeon satisfaction index and number of uses per case were also reviewed.
  
  
  RESULTS
  Twenty-eight patients (85%) underwent sinonasal surgery and five (15%) underwent skull base surgery. Indications included infectious complications of acute sinusitis (N=15), neoplasms (N=12), choanal atresia (N=4), and cerebrospinal fluid leak (N=2). Thirty-one patients (94%) required only one procedure. No surgical complications were reported. Surgeon satisfaction, mean accuracy and number of uses per procedure increased over time (p<0.05).
  
  
  CONCLUSIONS
  Image guidance systems are safe and effective tools that facilitate a minimally invasive approach to sinonasal and skull base surgery in children. Consistent with adult literature, usage and surgeon comfort increased with experience. The additional anatomical information obtained by image guidance systems facilitates a minimally invasive endoscopic approach for sinonasal and skull base pathologies.
authors.affiliation: Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, 243 Charles Street, Boston, MA 02114, USA. Margo_Benoit@meei.harvard.edu
authors.forename: Margo McKenna
authors.initials: MM
authors.lastname: Benoit
authors.forename: V Michelle
authors.initials: VM
authors.lastname: Silvera
authors.forename: Richard
authors.initials: R
authors.lastname: Nichollas
authors.forename: Dwight
authors.initials: D
authors.lastname: Jones
authors.forename: Trevor
authors.initials: T
authors.lastname: McGill
authors.forename: Reza
authors.initials: R
authors.lastname: Rahbar
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000601:surgery; D010256:Paranasal Sinuses / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome