Experience with various 3-dimensional navigation systems in head and neck surgery

Objective: To evaluate the benefits and difficulties encountered when using various 3-dimensional (3-D) navigation systems in head and neck procedures . Design: Five different navigation systems were used for preoperative planni ng and intraoperative 3-D navigation in procedures at the paranasal sinuses , the frontal and lateral skull bases, and the petrous bone. Intervention: Intraoperative 3-D localizing systems (position-sensitive mec hanical arms, infrared cameras, etc) demand reliable patient fixation on th e operating table. We achieved this by developing a noninvasive head holder . Other systems allow patient movements by using magnetic digitizing techno logy (ARTMA System) and sophisticated programming. Results: Having surpassed an initial learning curve, we now achieve an accu racy of 1 to 2 mm regularly. Especially in paranasal and frontal basal surg ery, all navigation systems used provide valuable positioning information d uring surgery. In particular for revision or tumor surgery, decisive benefi ts resulted from use of these systems: shorter overall operation time; safe r manipulation near delicate structures; and reliable identification of the skull base even in patients with bleeding, scarring, or missing anatomical landmarks. Conclusions: We performed approximately 250 operations with different syste ms and introduced navigation at the lateral skull base and the petrous bone with mechanical, optic, and magnetic digitizers. In these anatomical areas , navigation was used successfully; the technical challenge is greatest at the lateral skull base, however.