Pre-FESS Checklist

Algorithmic CT analysis improving FESS safety represents a structured, anatomy-driven approach to preoperative radiological evaluation designed to reduce surgical risk and enhance procedural precision. Functional endoscopic sinus surgery relies heavily on accurate interpretation of high-resolution CT imaging, yet anatomical variability of the paranasal sinuses remains one of the primary challenges for surgeons. Misinterpretation of critical structures—including the skull base, orbit, anterior ethmoidal artery, Onodi cells, and sphenoid sinus relationships—can lead to severe intraoperative complications. This algorithmic system provides a step-by-step assessment of the nasal septum, middle turbinate, uncinate process, maxillary sinus, ethmoidal labyrinth, orbital boundaries, sphenoid sinus, and anterior skull base. For each anatomical zone, the algorithm highlights normal and variant anatomy, identifies high-risk configurations, and provides evidence-based surgical recommendations. By integrating structured CT interpretation with real-time surgical guidance, the model standardizes preoperative planning and reduces dependence on subjective radiologic judgment. Special emphasis is placed on identifying “critical anatomical zones,” such as dehiscent orbital walls, low-lying AEA canals, optic nerve or ICA protrusions, hypoplastic sphenoid sinuses, and deep olfactory fossae (Keros III-IV). The presence of even one of these features significantly elevates the risk of complications during endoscopic sinus surgery. The algorithm flags such findings and suggests modifications in surgical trajectory, visualization angles, and instrument use. The system improves surgical safety, supports reproducibility of decision-making, and serves as an educational tool for trainees. By transforming complex CT interpretation into a guided, structured workflow, algorithmic CT analysis enhances the reliability, accuracy, and anatomical awareness essential for safe and effective FESS.