Prospective evaluation of intraoperative computed tomography imaging for endoscopic sinonasal and skull-base surgery

Background: The objective of this study was to prospectively evaluate the clinical impact of intraoperative computed tomography (CT) imaging on endoscopic sinonasal and skull base procedures. Methods: A total of 49 patients were enrolled after informed consent from December 2009 to May 2010. Patients underwent intraoperative volume CT imaging (xCAT, Xoran Technologies, Ann Arbor, MI) at the conclusion of their proposed surgery. Results: The mean age was 48.6 years with male:female ratio of 1.3:1. Surgical procedures included revision or primary endoscopic sinonasal surgery (ESS) (36), endoscopic benign or malignant tumor resection (10), endoscopic mucocele drainage (2), and endoscopic tumor biopsy (1). The mean Lund-Mackay (L-M) score was 10.6 (range 1-21). The indications for intraoperative imaging included extent of paranasal sinus dissection in 38 (77.6%), extent of tumor resection in 11 (22.4%), adequacy of mucocele drainage in 3 (6.1%), and frontal stent position in 2 (4.1%) cases. Average acquisition time was 5.3 minutes. The CT acquisition quality was deemed excellent in 24 (49.0%), good in 15 (30.6%), fair in 5 (10.2%), and unattainable in 5 (10.2%) cases. Additional interventions were performed in 8 of 44 cases (18%) based on the intraoperative CT dataset. Analysis of predictive factors for additional intervention, including presence of polyps, presence of tumor, previous surgery, use of image guidance, and CT quality did not reach statistical significance. Conclusion: Intraoperative CT scanning may hold important utility in selected endoscopic sinonasal and skull base procedures with additional interventions being performed in 18% of cases. The present study was unable to identify specific factors that would preoperatively predict the need for intraoperative imaging. Future clinical trials should include a multi-institutional design to better delineate these important variables.