Indications and limitations of intraoperative navigation in maxillofacial surgery

Although primarily developed for neurosurgical application, intraoperative navigation has gained acceptance even in maxillofacial surgery with an increasing field of indications. We want to demonstrate our clinical experiences, focusing on the indications and limitations of intraoperative navigation.

In our department, the navigation system VectorVision (BrainLAB, Heimstetten, Germany) is used. The accuracy of this referencing method, consisting of a cortical fixed reference system and surface scanning, was checked by anatomic landmarks. Surgical treatment of 20 patients was performed with the help of the navigation system.

The VectorVision system proved to be a useful supplement during the surgical exploration of complex anatomic regions. However, resolution of imaging data sets, errors of image fusion, and discrepancies during referencing increased the inaccuracy before surgery. The main problem was the topographic changes caused by surgery, resulting in discrepancies between the preoperative image data and the surgical site. In one case suffering from a meningioma extending to the neck, topography was changed by surgery making navigation inaccurate.

Generally, a promising field for intraoperative navigation systems were small surgical approaches allowing only limited exposure. From our point of view, additional promising indications include vast tumors or recurrent tumors because of altered anatomy with lost landmarks during surgery. The same was the case of patients suffering from plexiform neurofibroma caused by neurofibromatosis type I. Further, intraoperative navigation was helpful to determine the position of foreign bodies during imaging, making the intraoperative location easier.