“CT guidance has caught on remarkably well, because it’s easy to set up, and everybody can get a CT scan before sinus surgery,” said Dr. Fried. “It reduces the incidence of adverse events and allows a surgeon to get more accomplished because they know where they are in the anatomy. MRI, however, never really caught on universally because it is very expensive and you need a lot of equipment compatible with a high magnetic field, he said.
Explore This IssueMay 2015
CT scans have also been critical for sino-nasal and skull base surgery, said Timothy Smith, MD, MPH, chief of rhinology and sinus surgery, professor of otolaryngology–head and neck surgery at Oregon Health and Science University in Portland, and an ENTtoday editorial advisory board member. “There were early adopters of the technology. but it has found a home even in mainstream otolaryngology,” he said. “I think most surgeons across the country have access to it.”
How Imaging Is Used Now
Combining the CT and MRI technologies is fairly novel—Dartmouth opened its intra-operative imaging center in February 2014—and only 40 other medical centers in the United States, including Brigham and Women’s Hospital in Boston and Barnes-Jewish Hospital in St. Louis, Mo., offer this combination of scanning in the operating room.
At Dartmouth, the first U.S. location to install the machines and receive FDA approval, imaging machinery is suspended on ceiling railings that slide in and out of place in four operating rooms, said Sohail K. Mirza, MD, MPH, medical director of the Center for Surgical Innovation, professor and chair of the department of orthopaedics at Dartmouth’s Geisel School of Medicine. While such technology is still in its earliest stages of use in otolaryngology procedures, it has been used for surgery of the brain, breast, lung, prostate, liver, pancreas, kidneys, and spine.
In these procedures, the extra perspective is helpful. “It’s useful to have a three-dimensional map of where you are and what lies below the surface,” said Dr. Mirza, particularly in cases where the anatomy has a deformity or a congenital malformation. For pediatric spinal cases, where the area is small and patients often don’t have “the normal anatomical landmarks surgeons use for orientation,” the technology has been beneficial, he said.
In a recent spinal case he oversaw, Dr. Mirza described a 75-year-old patient with arthritis-related tumors and curvature of the spine resulting in pinched nerves, spinal stenosis, and numbness/weakness going down the legs. “The patient had already seen five spin surgeons and all recommended a huge surgery to fuse most of the lower back, taking eight to 10 hours. This kind of scoliosis surgery in older adults can take a year to recover from, with a high risk of potentially serious complications,” Dr. Mirza said. “He came to me and said, ‘I am very active. Can you do something to free up my nerves without having to fuse my back?”