[Neuronavigation in transnasal endoscopic paranasal sinuses and cranial base surgery: comparison of the optical and electromagnetic systems].
Transnasal endoscopic operative methods became increasingly popular in paranasal sinuses and cranial base surgery. Various types of localization systems are recently used to navigate through and between tangled anatomical structures in this region. The aim of this study was to compare (as basing on our own clinical experience), the advantages and limitations of the optical and electromagnetic neuronavigation systems.


METHODS
Optical neuronavigation system (Stealth Station Treon plus, Medtronic, U.S.A.) and electromagnetic neuronavigation systems (DigiPointeur, Collin, France and Fusion ENT, Medtronic, USA) were used during endoscopic operations of paranasal sinuses, anterior skull base, orbits, parasellar region and clivus. The subject of comparison were precision of both system types and additional time necessary for setting up the system. Also assessed were convenience of navigation and easiness of manipulation with neuronavigated instruments during surgical procedures performed using classical endoscopic technique, bimanual technique and four hand technique.


RESULTS
The accuracy was high and comparable for both system types and did not deteriorate during the procedure. The time needed to set up of the optical system was somewhat longer. Surgeon's comfort during operative procedures was assessed as slightly higher for the electromagnetic systems, especially if four hand or bimanual techniques were used and if constant neuronavigation was indispensible. The optical system allows for navigation of a variety of surgical tools and this was considered a great advantage over the electromagnetic systems in this particular application.


CONCLUSIONS
The additional time spent in the operative theatre for getting a system ready is well paid off by better orientation of a surgeon in the operative field consequently increasing safety and higher accuracy of surgical procedure. What system should a surgeon use depends to a great extent on the type of planed procedure and preferred surgical technique.
Sieśkiewicz
Andrzej
A
Klinika Otolaryngologii Uniwersytetu Medycznego W Białymstoku. sieska@interia.pl
Łysoń
Tomasz
T
Mariak
Zenon
Z
Rogowski
Marek
M
D004869:Equipment Safety; D006801:Humans; D009296:Nasal Cavity / Q000601:surgery; D044583:Neuroendoscopy / Q000379:methods*; D038361:Neuronavigation / Q000295:instrumentation*; D010254:Paranasal Sinus Diseases / Q000601:surgery*; D011044:Poland; D012852:Sinusitis / Q000601:surgery; D019291:Skull Base / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D013525:Surgical Instruments