The feasibility of using magnetic resonance imaging scans for endoscopic sinus surgery

BACKGROUND: We have previously shown that an adjusted magnetic resonance imaging (MRI) protocol could be used as an alternative for assessing most bony paranasal and vital structures. Here, we aimed to determine the feasibility of using this protocol during endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). METHODS: Three experienced rhinologists used an adjusted MRI scan to plan and perform ESS. They were blinded to the CT images and observed them only postoperatively. They also completed a detailed questionnaire about their experience. RESULTS: Forty-three patients with CRS (60.5% with polyps and 39.5% without polyps) were included in the study. MRI navigation was used in 58.3% and 33.3% of surgeries performed by surgeon #1 and #2, respectively. The median Lund-Mackay score was 12 (interquartile range 2-24). None of the surgeons switched entirely to using CT scans during the procedure; No intra or postoperative complications were observed. Two surgeons reported that it was convenient to work with the MRI scans to visualize all nasal sinuses, but the third surgeon found MRI scans convenient for visualizing the frontal sinus. MRI convenience was considered superior to CT in 7 cases (16.3%), the same as CT in 29 cases (67.4%), and inferior to CT in 7 cases (16.3%). All three surgeons agreed that using MRI scans intraoperatively for ESS is safe and comparable to using CT scans. CONCLUSION: MRI is a well-suited modality for planning and performing ESS. Rhinologists would be able to rely on it in specific and highly selected indications.