Indications for image-guidance in pediatric sinonasal surgery

Objectives: To determine the indications and safety of image-guidance for pediatric sinonasal surgery. Methods: A retrospective review was carried out of all patients undergoing image-guided sinus surgery using a single electromagnetic navigation system. All patients less than 18 years who underwent image-guided endoscopic sinus surgery over a 5-year period at a tertiary children's hospital were included. The means and ranges of age, preoperative setup time, gender distribution, and indications for surgery were determined. Operative time, anatomic regions explored, and intraoperative complications were also analyzed. Results: Thirty-three patients underwent image-guided surgery over a 5-year period. The mean age was 12 years, with 23 males and 10 females. Mean operative time and preoperative setup time was 128 and 43 min, respectively. Indications for surgery included chronic (30.3%) and acute (12.1%) rhinosinusitis, nasopharyngeal angiofibroma (9.1%), allergic rhinosinusitis (9.1%) and allergic fungal sinusitis (9.1%). Conclusions: This series represents the largest collection of pediatric image-guided sinus surgery. In our population, image-guidance was only used for advanced sinonasal procedures where there was an anatomic abnormality or disease that extended to the sphenoid sinus, frontal sinus, orbit, or skull base. No complications were noted.