Ewers et al. reviewed 158 operations with successful use of IGS concluding that in the majority of cases, the medical benefit outweighed the technical expenditure . Jeelani et al. utilized the StealthStation intraoperative navigation system to successfully perform a frontofacial monobloc distraction on a child with Apert syndrome . Children with Pierre Robin Sequence, craniofacial microsomia, Treacher Collins, Crouzon (1 in 60,000), and Apert syndromes (1 in 65,000) can gain great functional and aesthetic benefits after such procedures [5, 6].
We describe our experience relative to 1) perceptions and 2) expenditures of IGS for this one patient. It is our perception that IGS, while not necessary for most routine craniomaxillofacial surgery is useful 1) as a teaching tool in the OR to highlight anatomy and 2) as an adjunct in cases of unusual anatomy, revision surgery, or complicated reconstructions. There is little or no data in the craniofacial literature in terms of improved safety, outcomes, patient aesthetics, or decreased need for further surgery. Our perceptions in terms of potential downsides of IGS include increased time in the OR for setup and small risks of mounting fiducial marker in the case of infrared IGS systems. There are additional costs including those needed for preparation and performance of surgical procedures supported by IGS. The FUSION™ ENT on Medtronic StealthStation S7 Surgical Navigation System costs $359,000 and this as well as the $18,900 for the supplemental instrument set, and $1,076 for the new surgeon wireless mouse are fixed costs though in our case these were on trial by the hospital. The recurring costs include the StealthStation® Spheres, which come 12 in a pack for $20 per sphere and any additional anesthesia costs ($482/h) during the setup and calibration of the IGS. The total recurring costs were $481.
Recurring costs that are not part of the IGS system include the cost of the rigid external distraction (RED) system (KLS Martin, Jacksonville, FL) and the stereolithographic model (SLM), which totaled $14,500. The hospital stay accrued to $33,144 in the pediatric intensive care unit and $8,384 on the pediatric floor. The sum of these expenditures ($56,028) far exceeds the recurring costs of the IGS. The financial benefit of improved clinical outcomes or decreased complications is unknown at this point—ideally randomized case controlled studies would help in answering such questions although it would be impossible to blind such studies.