[Application of frameless neuronavigation in urgent neurosurgery]

Application of a novel technique is analyzed. Frameless CT-based navigation was applied for planning of surgical approach in 92 patients aged 14 to 69 with acute intracranial hemorrhage of different etiology (43 cases of hypertensive hemorrhages, 10 cases of traumatic intracranial hematomas and 16 cases of secondary non-traumatic intracerebral hematomas). Comparative analysis of radioopaque markers and natural anatomical landmarks for registration of patients showed that anatomical landmarks are sufficient for surgical planning without significant distortion of approach trajectory (mean error was 2.2 +/- 1 mm) in supratentorial haemorrhage. This discovery simplified the application of neuronavigation in emergency cases. In posterior fossa hematomas additional radioopaque markers are essential due to absence of constant anatomical landmarks in occipital region. Applicatyion of frameless neuronavigation in surgical treatment of acute intracranial hemorrhages may diminish intraoperative damage to the brain tissue and decrease invasiveness of the operation because of high accuracy of planning of surgical approach. This technique has good perspectives in emergency neurosurgery.