Neuronavigation--first experiences with three different commercially available systems

Growing interest in neuronavigation also referred to as frameless stereotaxy has led to the development of various navigational devices employing different localization methods. In 152 procedures the authors have used neuronavigation. Cases included 89 intracranial- and 26 skull base tumours, 9 biopsies, 21 vascular and 7 functional procedures on 144 patients since July 1993. In 75 cases the lesions were located in eloquent areas. In 82% (124) MRI, 13% (18) CT and 5% (8) both imaging methods were employed. Three neuronavigational devices with different localization methods were used for the procedures. The Viewing Wand (VW, ISG, Canada), a multijointed arm was used in 101 procedures. In 15 cases the SPOCS (Aesculap, Germany) consisting of cameras detecting infrared light from LED's mounted on instruments and in 51 cases the microscope-integrated MKM (ZEISS, Germany) was investigated, 15 times two systems were used simultaneously. Mean time necessary for preoperative registration was 23 +/- 13 min (VW), 21 +/- 16 min (SPOCS) and 27 +/- 22 min (MKM) respectively. The mean accuracy of registration measured as RMS was 2.9 +/- 1.2 mm (VW), 3.3 +/- 0.9 mm (SPOCS) and 3.1 +/- 1.0 (MKM) respectively. Regarding intraoperative handling the VW was found to be a robust but sometimes bulky and hindering device whereas the SPOCS was more flexible but with the need of unobstructed visibility between cameras and pointers. The MKM without these restrictions required training to get used to handling.