Use of the Brainlab Disposable Stylet for endoscope and peel-away navigation

Neuronavigation, the ability to perform real-time intra-operative guidance during cranial and/or spinal surgery, has increased both accuracy and safety in neurosurgery [2]. Cranial navigation of existing surgical instruments using Brainlab requires the use of an instrument adapter and clamp, which in our experience renders an endoscope 'top-heavy', difficult to manipulate, and the process of registration of the adapter quite time-consuming.

A Brainlab Disposable Stylet was used to navigate fenestration of an entrapped temporal horn in a pediatric case. Accuracy was determined by target visualization relative to neuronavigation targeting. Accuracy was also calculated using basic trigonometry to establish the maximum tool tip inaccuracy for the disposible stylet inserted into a peel-away (Codman) and endoscope.

The Brainlab Disposable Stylet was easier to use, more versatile, and as accurate as use of an instrument adapter and clamp. The maximum tool-tip inaccuracy for the endoscope was 0.967 mm, and the Codman peel-away 0.489 mm. A literature review did not reveal any reports of use of the Brainlab Disposable Stylet in this way, and we are unaware of this being used in common neurosurgical practice.

We would recommend this technique in endoscopic cases that require use of Brainlab navigation.