What are the advantages and clinical application of image guided surgery in ENT?

Image guided surgery is the general term used for any surgical procedure where the surgeon employs tracked surgical instruments in conjunction with preoperative or intraoperative images in order to indirectly guided the procedure.

It is a virtual 3 dimensional mapping system that combines CT scans of patient abnormally and real-time information about the exact of surgical instruments using infrared signals.

The advantages are:

  1. Surgical planning : It helps to diagnose and asses the extent and treatment plan. It helps to familiarize the anatomy and surgical need of patient.
  2. Surgical simulation (practice a certain surgical procedure): makes surgery safer and the training of future surgeons better
  3. Provides intraoperative positional information and localization.
  4. Reduce complications
  5. Aids in revision surgery or in disease distorted anatomical state.

Clinical applications

Skull base

  • Design of bone flaps
  • identification of important structure
  • For finding tumours (small) in obscure parts.
  • Maximize excess to correct basilar imagination in a patient with osteogenens imperfecta


  • Used in difficult revision FESS where there are no recognizable anatomical landmasses
  • Useful to localize frontal recess during draft type and three procedures of frontal sinus to be opened.
  • Reduces the needs to perform open and external procedures
  • Transnasal/ trans-sphenoidal hypophysectomy
  • Dehiscent lamina papyracea


  • Locating the facial nerve
  • Identifying the lesion of the petrous apex
  • Tumours particularly in IAC e.g VS meningioma
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