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Real-time computed tomography image update for endoscopic skull base surgery

  • B A Woodworth (a1), A G Chiu (a1), N A Cohen (a1), D W Kennedy (a1), B W O'Malley (a1) and J N Palmer (a1)...

The development of computer-aided systems for endoscopic sinus surgery has enabled surgical navigation through diseased or surgically altered sinus anatomy with increased confidence. However, conventional computer-aided systems do not provide intra-operative updated computed tomography imaging. We describe the technical aspects of the xCAT™, a new intra-operative mobile volume computed tomography scanner.

Technical report:

A patient with a malignant melanoma unwittingly removed at another hospital underwent surgery for removal of the lateral nasal wall and directed biopsies, in an attempt to identify the site of tumour origin. The procedure was performed with the GE InstaTrak 3500 PlusTM computer-aided system, updated with intra-operative computed tomography images. Intra-operative, updated images were integrated successfully into the InstaTrak system, and these images were consistent with the observed endoscopic anatomy.


The xCAT intra-operative mobile volume computed tomography scanner is a technological advancement that can assist the endoscopic sinus surgeon when performing complex rhinological and skull base procedures.

Corresponding author
Address for correspondence: Dr James N Palmer, Division of Rhinology, Dept of ORL:HNS, 3400 Spruce Street, Philadelphia, PA 19104, USA. Fax: (215) 614 0071 E-mail:
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1 JH Perry , AE Rosenbaum , LD Lunsford , CA Swink , DS Zorub . Computed tomography/guided stereotactic surgery: conception and development of a new stereotactic methodology. Neurosurgery 1980;7:376–81

2 M Cartellieri , F Vorbeck . Endoscopic sinus surgery using intraoperative computed tomography imaging for updating a three-dimensional navigation system. Laryngoscope 2000; 110:292–6

3 JH Siewerdsen , DA Jaffray . Cone-beam computed tomography with a flat-panel imager: magnitude and effects of x-ray scatter. Med Phys 2001;28:220–31

4 P Sukovic . Cone beam computed tomography in craniofacial imaging. Orthod Craniofac Res 2003;6(suppl 1):31–6, 179–82

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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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