Utility of novel 3-dimensional stereoscopic vision system for endoscopic sinonasal and skull-base surgery

Background: The objective of this pilot study was to evaluate the utility of novel 3-dimensional (3D) endoscopy during endoscopic sinonasal and skull base surgery. Methods: Eight surgeries were performed in 7 patients between August 2009 and March 2010 at a tertiary care academic medical center. A high-definition 2-dimensional (2D) endoscopy system was employed in all cases. The Visionsense stereoscopic system (Orangeburg, NY) was incorporated during key portions of the procedures. Two independent surgeons assessed utility of the technology for the following 2 variables: (1) ability to facilitate orientation and depth perception; and (2) impact on completeness of surgery and potential complications. Results: The mean age was 50.4 years and the male:female ratio was 6:1. Indications included anterior skull base (ASB) tumor resection (5), directed skull base biopsies (2), and ethmoid dissection adjacent to dehiscent skull base/optic nerve in allergic fungal rhinosinusitis (1). Endoscopic orientation and depth perception was aided using the 3D endoscope in all cases. Additional interventions were performed in 3 cases (37.5%), including tumor resection (1) and removal of remnant ethmoid partitions (2). Limitations posed included inability to visualize a type III frontal cell (1) and loss of orientation during ASB reconstruction due to overmagnification (1). No complications were observed in this patient series. Conclusion: This preliminary study demonstrated the effectiveness of binocular 3D endoscopy during sinonasal and skull-base surgery. The technology facilitated depth perception and completeness of surgery without increase in complications. Additional experience is warranted to define its role in the endoscopic surgical paradigm.