Navigation Surgery at the Base of the Skull

Surgical navigation plays an important role in the surgery of the base of the skull, the paranasal sinuses, and the temporal bone. It was introduced in paranasal sinus surgery and is well established. The accuracy in this area is excellent. Nowadays there are different types of navigation systems available. These are optoelectronic and electromechanical devices. The registration has also advanced in the last few years. Today's standard is surface scanning by laser, for example. Surgeons are becoming increasingly interested in using this technique for the lateral skull base in addition to its application for the anterior skull base. Anatomic structures such as labyrinth and cochlea demand excellent accuracy of the system. This problem, however, seems not yet to be satisfactorily solved.

In a roundtable discussion we present actual and established devices and evaluate navigation in the surgery of paranasal sinuses and anterior base of skull in polypoid sinus diseases and in tumors. We also deal with the still problematic navigation at the lateral base of skull. Another contribution will consider future developments of surgical navigation of the skull base.