A novel protocol of continuous navigation guidance for endoscopic third ventriculostomy

Area of Science:

• Neurosurgery
• Medical Imaging
• Surgical Navigation

Background:

• Endoscopic third ventriculostomy (ETV) is a standard neurosurgical procedure.
• ETV has a high complication rate, often due to trajectory malpositioning.

Purpose of the Study:

• To develop an advanced navigation protocol for ETV.
• To assess the benefits of this protocol compared to standard ETV trajectories.
• To apply the protocol in surgical settings.

Main Methods:

• Developed an advanced navigation protocol for ETV.
• Compared individualized trajectories with standard trajectories using pre-operative imaging data from 59 patients.
• Applied the protocol in 15 ETV surgeries to evaluate feasibility and complications.

Main Results:

• The individualized ETV trajectory significantly increased the distance to the foramen of Monro margins.
• The burr hole placement was more posterior compared to standard trajectories.
• The advanced technique was feasible in all 15 cases with no major complications; one patient had a minor fornix contusion.

Conclusions:

• The proposed navigation protocol optimizes endoscope distance to critical neuronal structures during ETV.
• Continuous guidance during ETV may enhance procedural safety.