Objective: To evaluate the use of image guidance systems to facilitate an endoscopic minimally invasive approach to sinonasal and skull base surgery in a pediatric population. Study Design: Retrospective cohort study at a tertiary pediatric hospital. Methods: Thirty-three children presented between March 2000 and April 2007 with complications of acute sinusitis or tumors/congenital lesions of the sinonasal region or skull base and underwent endoscopic surgery using image guidance. Patient variables including diagnosis, extent of disease, and complications were extracted from paper and computer charts. Additional surgical variables including set-up time, accuracy, surgeon satisfaction index and number of uses per case were also reviewed. Results: Twenty-seven patients (82%) underwent sinonasal surgery and six (18%) underwent skull base surgery. Indications included infectious complications of acute sinusitis (N=15), neoplasms (N=12), choanal atresia (N=4), and cerebrospinal fluid leak (N=2). Thirty patients (91%) required only one procedure. No surgical complications were reported. Conclusions: Image guidance systems are safe and effective tools that facilitate a minimally invasive approach to sinonasal and skull base surgery in children. Consistent with adult literature, initial use of image guidance during the learning period tends to involve routine procedures while over time image guidance is used for difficult or revision cases. The additional anatomical information obtained by image guidance systems helps in the minimally invasive endoscopic approach for sinonasal and skull base pathologies.
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