Optical Neuronavigation without Rigid Head Fixation During Awake Surgery.

Area of Science:

• Neurosurgery
• Medical Technology
• Image-Guided Therapy

Background:

• Patient movement during awake surgery can compromise optical neuronavigation accuracy without rigid head fixation.
• Eloquent gliomas require precise surgical techniques to maximize tumor resection while preserving neurological function.

Purpose of the Study:

• To evaluate the efficacy and safety of a skull-mounted reference array for optical neuronavigation during awake craniotomy.
• To assess the accuracy of optical tracking without rigid pin fixation in patients with eloquent gliomas.

Main Methods:

• 18 patients with frontotemporal or frontoparietal gliomas underwent awake craniotomy.
• A skull-mounted reference array was used for optical tracking, avoiding rigid pin fixation.
• Navigation accuracy was measured by pointer tip deviation, with <2 mm considered good accuracy.

Main Results:

• Gross total resection (>98%) was achieved in 38% of patients; >90% resection in 44%.
• Accurate optical neuronavigation was demonstrated in all patients without complications.
• The system reliably supported stimulation-based tumor resection.

Conclusions:

• A skull-mounted reference array offers a simple, safe, and effective solution for optical neuronavigation in awake craniotomies.
• This technique eliminates the need for rigid pin fixation, improving patient comfort and potentially reducing risks.
• It facilitates precise tumor resection in challenging cases involving eloquent gliomas.