Criteria for Image-Guided Surgery

The American Academy of Otolaryngology – Head and Neck Surgery endorses the intraoperative use of computer-aided surgery in appropriately select cases to assist the surgeon in clarifying complex anatomy during sinus and skull base surgery. There is sufficient expert consensus opinion and literature evidence base to support this position. This technology is used at the discretion of the operating surgeon and is not experimental or investigational. Furthermore, the American Academy of Otolaryngology—Head and Neck Surgery is of the opinion that it is impossible to corroborate this with Level 1 evidence. These appropriate, specialty specific, and surgically indicated procedural services should be reimbursed whether used by neurosurgeons or other qualified physicians regardless of the specialty.

Examples of indications in which use of computer-aided surgery may be deemed appropriate include:
  • Revision sinus surgery.
  • Distorted sinus anatomy of development, postoperative, or traumatic origin.
  • Extensive sino-nasal polyposis.
  • Pathology involving the frontal, posterior ethmoid and sphenoid sinuses.
  • Disease abutting the skull base, orbit, optic nerve or carotid artery.
  • CSF rhinorrhea or conditions where there is a skull base defect.
  • Benign and malignant sino-nasal neoplasms.
Related terminology: Image guided sinus surgery, computer-assisted sinus surgery, surgical navigation, computer-guided imaging systems.

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Anon JB, Rontal R., Zinreich SJ, “Computer assisted endoscopic sinus surgery-current experience and future developments,”Otolaryngology—Head and Neck Surgery, 1995; 6:163-170
Fried MP, Kleefield J., Gopal H, et al.“Image-guided endoscopic surgery:results of accuracy and performance in a multicenter clinical study using an electromagnetic tracking system,” Laryngoscope, 1997; 107:594-601
Metson R, Gliklich RE, Coseneza MJ.“A comparison of image guided systems for sinus surgery,” Laryngoscope, 1998; 108:1164-1170.
Metson R, Coszena MJ, Gliklich RE, Montgomery WW, “The role of image guided systems for head and neck surgery,”Archives of Otolaryngology—Head and Neck Surgery, 1999, 125:1100-1104.
Metson R, Coszena MJ, Cunningham MJ, Randolph GW, “Physician Experience with an optical image guided system for sinus surgery,”Laryngoscope 2000;110:972-976.
Neumann AM, Pasquale-Niebles K, Bhuta T., Sillers MJ, “Image-guided transnasal endoscopic surgery of the paranasal sinuses and anterior skull base,”American Journal of Rhinology 1999; 13:449-454.