Experience with a new multifunctional articulated instrument holder in minimally invasive navigated neurosurgery

A new multifunctional articulated instrument holder for use in minimally invasive navigated neurosurgery is presented. The instrument holder is secured to the Mayfield clamp, yielding permanent fixation and guidance of instruments. Thus, surgical conditions with the advantages of both conventional and frameless stereotaxic neurosurgery are created without sacrificing the relevant advantages of both methods. Accuracy testing of the instrument holder in combination with the neuronavigation system EasyGuide Neuro demonstrated an error of 0.0 to 2.4 (mean 1.6) mm. In clinical testing, the device has been used for guided catheter insertions, pointer fixation for continuous intraoperative guidance and trajectory planning, navigated endoscopic procedures, and navigated intracerebral biopsies in totally 53 patients.