Use of surgical navigation during endoscopic skull base surgery

The use of surgical navigation has grown tremendously in endonasal endoscopic surgery. The technology has been used as an adjunct during endoscopic surgery of the skull base. Although not requisite, the benefits of navigation during endoscopic skull base surgery may lie in its ability to enhance a surgeon's approach to complex anatomic structures. The use of navigation during endoscopic skull base surgery does not completely parallel its use during surgery for inflammatory sinus disease, and those differences can be critical. For example, in endoscopic skull base surgery, soft tissue structures play a more prominent role during the dissection than in a typical surgery for inflammatory disease. Preoperatively, there are some particular issues that a navigated case will require above and beyond a non-navigated surgery, including obtaining appropriate radiographic studies, performing the appropriate preoperative software-based planning, and discussions with the patient. Intraoperatively, the set up of the navigation system in the operating room should augment the surgeon's operative field and maximize the utility of the navigation system. Specific indications where navigation may be useful include the endoscopic approach to sellar and parasellar lesions, benign anterior skull base tumors, encephaloceles, CSF leaks, and the like. The endoscopic surgeon who is performing skull base procedures should consider computer assisted navigation to be a helpful tool in his/her armamentareum.