Optical tracking of a microscope for image-guided intranasal sinus surgery.

The objective of this study was to examine the effects of optical and tracking properties on the accuracy of an optically locatable operating microscope. The intraoperative arrangement was based on experimental results obtained from a skull model. Measurements were taken from 24 patients undergoing intranasal microscopic sinus surgery for various disorders. Two major groups of influencing factors were determined from measurements on the model: 1) optical properties of the microscope, such as the method of focal point adjustment, focal length, and magnification of the lens; and 2) tracking properties of the microscope, such as the distance of the digitizer to the tracked object, the number of reference infrared light-emitting diodes (IR-LEDs), and the area circumscribed by these IR-LEDs. Patient measurements showed an overall spatial error of 2.39+/-1.15 mm with a laser-supported adjustment of the focal point of the microscope. Although the associated 95th percentile was at 4.36 mm, such a value is encouraging for further development of microscopically navigable systems. It must be noted that the noninvasive patient-to-image registration was performed on the basis of a computed tomographic image with a slice distance of 2 mm.