Possibilities and developments of intraoperative image-guided surgery in craniofacial surgery

The standardised operational techniques of fronto-orbital osteotomy and the various modifications used today make it possible to perform extensive surgery for the treatment of craniofacial malformations and advanced tumours in this region, while also allowing for a good extra- and intracranial view. Osteotomies and resections in areas of the skull base that are normally hard to reach have been considerably facilitated and the operational risk has been lowered. Our aim is to achieve a further reduction of the operational risks and of the post-surgical morbidity rate through the use of techniques of computer-assisted surgery. Especially in the area of the complex anatomy of the skull base, use of the systems for the purpose of orientation and realisation of operational planning as well as for the control of how radical a tumour resection needs to be, have proved quite successful. Meanwhile, we have acquired experience in more than 100 clinical applications of mechanical and optoelectronical navigation systems. However, it is not possible to make changes to the presurgical data. Also, the flexibility of the system is still somewhat limited. By introducing a new referencing system, the flexibility and possible applications of navigation have been increased. The current possibilities and indications for the use of intraoperative navigation are discussed.