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Basic principles and clinical applications of neuronavigation and intraoperative computed tomography
P Grunert1, W Müller-Forell, K Darabi
1Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany.
Summary
Frameless navigation and intraoperative computed tomography (CT) improve intracranial lesion localization and surgical planning. Intraoperative CT is particularly valuable for assessing tumor removal completeness.
Area of Science:
- Neurosurgery
- Medical Imaging
- Surgical Navigation
Background:
- Computed tomography (CT) and navigation systems offer 3-D localization of intracranial lesions.
- Intraoperative CT scanning can update image data and verify anatomy during surgery.
- Frameless navigation has been increasingly adopted in neurosurgical procedures.
Purpose of the Study:
- To evaluate the efficacy of frameless navigation and intraoperative CT in neurosurgery.
- To assess the accuracy and utility of these technologies for lesion localization and surgical guidance.
- To determine the impact of intraoperative CT on the radicality of tumor removal.
Main Methods:
- Frameless navigation (optical, sensory arm, navigated microscope) was used in 100 patients.
- Registration was performed using six skin markers, with a mean fiducial registration error of 2.18 mm.
- Intraoperative CT imaging was performed using a mobile CT scanner in 78 cases.
Main Results:
- Navigation was utilized for tumor localization, craniotomy planning, stereotactic biopsy, and endoscopic procedures.
- Technical issues occurred in 9 cases, and tumors were not found by navigation in 2 cases.
- Intraoperative CT identified residual tumor in 28% of cases, enabling further resection.
Conclusions:
- Frameless navigation is superior for localizing intracranial lesions.
- Intraoperative CT enhances the assessment of tumor removal radicality.
- Combining navigation and intraoperative CT improves surgical precision and outcomes in neurosurgery.