Removal of a low velocity projectile from the base of the sphenoid sinus using navigation-guided endoscopy

Abstract

Purpose: A patient surviving after a metal projectile penetrates the sphenoid sinus is unusual. Removing a foreign object from this region is challenging because of the difficult access and proximity to delicate structures. The use of navigation-guided endoscopy makes the manipulation of the surgical instruments near delicate structures safer and the procedure is minimally invasive. Patient: The case of a 67 year old male who shot himself while cleaning his airgun is presented. Results: A brain CT scan showed the projectile located at the base of the left sphenoid sinus. To prevent infection and irritation and avoid secondary surgical damage, navigation-guided endoscopy was used to remove the bullet. Using the BRAINLAB navigation system, the movement of the endoscope could be followed on the screen, and the tip could be navigated into close contact with the projectile. The bullet could be located, without being visible through the endoscope, making the incision and removal of the bony wall of the sinus minimal; it was removed without complications. Intra-operative navigation of endoscopes is very useful because it enables the surgeon to correlate the visual information through the endoscope with the localization of the instruments seen on the navigation screen. Patient safety and reinforced self-confidence of surgeons are advantages of this procedure. Reduced operative time may not always occur because of a lack of experience with the navigation system. Conclusion: When there are no vascular or neurological complications, a minimally invasive treatment using nasal navigation-guided endoscopic removal can limit the potential surgical damage.