Our Summary

This research paper is about the use of image-guidance systems (IGS) in endoscopic sinus surgery (ESS) for patients with chronic rhinosinusitis, an inflammation or infection of the sinuses. The researchers wanted to investigate if using IGS during the surgery could improve the quality of treatment by ensuring that all parts of the sinuses affected by the condition were treated.

To do this, they carried out a pilot study where they compared the results of surgeries with and without IGS from January 2011 to June 2012. They used CT scans taken before and after the surgery to identify which parts of the sinuses needed treatment and to evaluate the effect of the surgery. They then calculated a ‘missing ratio’ - the proportion of affected sinus compartments that were not treated during the surgery.

They found that out of the 169 patients who had ESS, 10 patients who had surgery with IGS and 10 patients who had surgery without IGS met the criteria for inclusion in the study. The median missing ratio for patients without IGS was 36%, while for those with IGS it was 0%. However, the missing ratio depended on the number of sinus compartments that needed treatment.

The results suggest that IGS can help surgeons to treat all diseased sinus compartments more effectively. However, the researchers suggest that a further comparative study of ESS with and without IGS is needed, using the missing ratio as the primary measure of success.

FAQs

  1. What is the purpose of using image-guidance systems (IGS) in endoscopic sinus surgery (ESS)?
  2. How was the ‘missing ratio’ calculated in the study and what did it indicate?
  3. What were the main findings of the pilot study comparing sinus surgeries with and without IGS?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sinus surgery is to discuss the option of using image-guidance systems (IGS) during the surgery. IGS can help ensure that all affected sinus compartments are treated effectively, potentially improving the outcome of the surgery. It is important to have a thorough discussion with your surgeon about the benefits and risks of using IGS in your specific case.

Suitable For

Patients who are typically recommended sinus surgery include those with chronic rhinosinusitis that has not responded to other treatments such as medication or nasal sprays. These patients may experience symptoms such as nasal congestion, facial pain or pressure, headaches, and reduced sense of smell. Other indications for sinus surgery may include nasal polyps, sinus tumors, or structural abnormalities in the sinuses that are causing recurrent sinus infections.

In the case of the research paper on the use of IGS in ESS for chronic rhinosinusitis patients, those who met the criteria for inclusion in the study had persistent symptoms despite medical treatment and had evidence of disease on CT scans. These patients may have had multiple sinus compartments affected by the condition, making it difficult for surgeons to ensure that all diseased areas are adequately treated during surgery.

Overall, sinus surgery may be recommended for patients who have failed to improve with conservative treatments and who have persistent symptoms that significantly impact their quality of life. The use of technologies such as IGS can help surgeons to more accurately target and treat affected areas in the sinuses, potentially leading to better outcomes for patients with chronic rhinosinusitis.

Timeline

Before sinus surgery:

  • Patient experiences chronic symptoms such as nasal congestion, facial pain, headache, and loss of smell
  • Patient undergoes diagnostic tests such as CT scans to assess the extent of sinus inflammation or infection
  • Patient may try conservative treatments such as nasal sprays, antibiotics, and steroids to manage symptoms

After sinus surgery:

  • Patient undergoes pre-operative evaluation to assess overall health and fitness for surgery
  • Surgery is performed using endoscopic techniques to access and treat affected sinuses
  • In cases where IGS is used, CT scans are taken before and after surgery to ensure all affected sinus compartments are treated
  • Recovery period involves post-operative care to manage pain, swelling, and prevent complications
  • Patient undergoes follow-up appointments to monitor healing and assess treatment outcomes

What to Ask Your Doctor

Some questions a patient should ask their doctor about sinus surgery, particularly if image-guidance systems are being used, include:

  1. Is image-guidance system (IGS) technology necessary for my sinus surgery, and how will it benefit me?
  2. What are the potential risks and benefits of using IGS during my surgery?
  3. How will IGS help ensure that all affected sinus compartments are properly treated during the surgery?
  4. What is the success rate of sinus surgeries using IGS compared to those without it?
  5. Will the use of IGS affect the length of my recovery time or post-operative care?
  6. Are there any additional costs associated with using IGS during the surgery?
  7. Can you explain how the missing ratio is calculated and how it will be used to evaluate the effectiveness of my surgery?
  8. What alternative treatment options are available if I choose not to use IGS during the surgery?
  9. Are there any specific pre-operative or post-operative instructions I need to follow if I opt for IGS-assisted sinus surgery?
  10. Can you provide me with more information or resources about the use of IGS in sinus surgery to help me make an informed decision?

Reference

Authors: Giotakis AI, Kral F, Freysinger W, Markart S, Riechelmann H. Journal: Int J Comput Assist Radiol Surg. 2019 May;14(5):895-902. doi: 10.1007/s11548-019-01930-4. Epub 2019 Mar 6. PMID: 30840184