Improving the Accuracy of Maxillary Sinus Balloon Dilation Using Virtual Reality Navigation: A Proof-of-Concept Study.

IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY American Journal of Rhinology & Allergy Pub Date : 2023-07-01 DOI:10.1177/19458924231164844
Dennis M Tang, Kevin Grafmiller, Satyan B Sreenath, Arthur Wu, William C Yao, Raj Sindwani
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引用次数: 1

Abstract

Background: The ability to reliably and accurately cannulate the natural ostium of the maxillary sinus during balloon sinus dilation (BSD) has been criticized. Conventional computed tomography (CT)-guided navigation systems are helpful when dilating other sinuses, but they fail to provide meaningful feedback to guide accurate dilation of the maxillary sinus.

Objective: This study explores the potential impact of a new navigation system with virtual reality (VR) functionality on successful BSD of the maxillary sinus.

Methods: Using the established methodology, a cadaveric evaluation of the accuracy of maxillary BSD with a VR-equipped navigation system and balloon was undertaken. The natural ostium was landmarked on CT images with a beacon, and a VR intrasinus camera view was used to guide balloon dilation by a team of 2 rhinologists. Following the procedure, uncinectomies were performed to directly assess the accuracy of dilation. Standardized video clips with a 30° endoscopic view of the area were reviewed by 3 blinded rhinologists from different institutions who were not part of the procedures. Dilation of the natural ostium was scored as "successful," "unsuccessful," or "unsure."

Results: Sixteen maxillary BSDs were completed in 8 cadavers using VR navigation. The medial wall of the maxillary sinus showing the natural ostium as well as any accessory ostia were readily visualized and labeled with a beacon in all cases using the 3D virtual rendering feature. Dilations were scored using a standardized rubric. Any "unsure" responses from the reviewers were categorized as "unsuccessful" for analysis purposes. The accuracy rate for dilation of the maxillary sinus natural ostium was 77%. Despite the use of cadaveric tissues, a fair interrater agreement (kappa 0.21) was achieved.

Conclusion: Using VR navigation appears to improve the accuracy of cannulating the natural ostium during maxillary BSD, which could lead to better outcomes. Further study in live subjects is warranted.

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使用虚拟现实导航提高上颌窦球囊扩张的准确性:一项概念验证研究。
背景:在球囊窦扩张术(BSD)中,上颌窦自然口的可靠和准确插管的能力一直受到批评。传统的计算机断层扫描(CT)导航系统在扩张其他鼻窦时是有帮助的,但它们不能提供有意义的反馈来指导上颌窦的准确扩张。目的:探讨虚拟现实(VR)导航系统对上颌窦BSD成功的潜在影响。方法:采用已建立的方法,利用虚拟现实导航系统和球囊对上颌BSD的准确性进行尸体评估。用信标在CT图像上标记自然口,由2名鼻内科医生组成的团队使用VR鼻窦内相机视图指导球囊扩张。手术后,行肿瘤切除术以直接评估扩张的准确性。来自不同机构的3名没有参与手术的盲眼鼻科医生对该区域30°内窥镜视图的标准化视频片段进行了审查。自然口扩张的评分为“成功”、“不成功”或“不确定”。结果:8具尸体采用VR导航完成了16例上颌bsd。在所有病例中,使用3D虚拟渲染功能,上颌窦内侧壁显示自然开口以及任何副开口都很容易被可视化并标记为信标。采用标准化评分方法对扩张进行评分。为了分析的目的,任何来自审稿人的“不确定”的回复都被归类为“不成功”。上颌窦自然口扩张的准确率为77%。尽管使用尸体组织,但获得了公平的判读协议(kappa 0.21)。结论:采用虚拟现实导航可提高上颌BSD自然口插管的准确性,可获得较好的治疗效果。进一步的活体研究是有必要的。
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来源期刊
CiteScore
5.60
自引率
11.50%
发文量
82
审稿时长
4-8 weeks
期刊介绍: The American Journal of Rhinology & Allergy is a peer-reviewed, scientific publication committed to expanding knowledge and publishing the best clinical and basic research within the fields of Rhinology & Allergy. Its focus is to publish information which contributes to improved quality of care for patients with nasal and sinus disorders. Its primary readership consists of otolaryngologists, allergists, and plastic surgeons. Published material includes peer-reviewed original research, clinical trials, and review articles.
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