Computer-aided surgery applications for sinonasal tumors and anterior cranial base surgery

The immediate reaction of those who do not perform endoscopic resection of neoplasms of the nose and paranasal sinuses and those who have not yet mastered this technique is one of skepticism. As with any new surgical approach, questions arise regarding the procedure’s safety, morbidity, efficacy, reliability, and cost-effectiveness compared to the accepted “standard of care.” Surgeons Copyrighted Material 277 278 Casiano and Carrau who are unfamiliar with endoscopic techniques cannot understand how these endoscopic techniques can incorporate fundamental oncological principles so that the endoscopic techniques achieve precision and tissue removal comparable with the more widely accepted, traditional external approaches. Advocates of external approaches are fast to note that facial, cranial, and/or gingival incisions are justifiable in order to attain good exposure and visualization of the surgical field; in this view, such exposure allows for more complete resections. Some surgeons even consider endoscopic treatments to be no more than piecemeal tumor resections. However, for experienced endoscopic surgeons, external incisions are not necessary to attain exposure and visualization. In fact, the visualization of the endoscopic alternative may be even greater than the standard external approaches. In general, most head and neck surgeons who are experienced with endoscopic approaches find few differences between the endoscopic and external procedures for selected lesions in regard to the degree of tissue removal and adequacy of visualization.