Frameless and Maskless Stereotactic Navigation with a Skull-Mounted Tracker:A Technical Report.

Frameless and Maskless Stereotactic Navigation with a Skull-Mounted Tracker:A Technical Report.

World Neurosurg. 2017 Mar 11;:

Authors: Fanous AA, White TG, Hirsch MB, Chakraborty S, Costantino PD, Langer DJ, Boockvar JA

Abstract
Intraoperative image-guided navigation has revolutionized neurosurgery. It undoubtedly increases the surgeon's confidence and the perception of safety. While fiducials and facial masks are currently the most widely used tools for intraoperative navigation, their use is associated with certain complications. For instance, such tools require rigid fixation of the head, which increases the risk of skull fractures and epidural hematomas, and decreases both surgical flexibility and surgeon's comfort. In addition, the use of a facial mask is at times undesirable, as it may represent an obstacle during surgeries involving the face and forehead. Furthermore, the use of these devices requires additional preoperative magnetic resonance imaging in the period immediately prior to the surgery, which is not cost-effective. In this case series, we present three cases that illustrate the usage of a skull-mounted tracker for image-guided navigation for anterior skull base surgery and ventricular catheter placement procedures. This system obviates the need for fiducials or face masks during the surgical procedure itself, and allows for the performance of facial incisions using the Weber-Ferguson approach. Moreover, our technique permits free movement of the head during surgery, which in turn facilitates the exposure of head-and-neck lesions and expedites the approach to ventricular catheter placement. Our case series demonstrates the precision and ease of our technique, which is less time-consuming and less cumbersome than the traditional frame-based stereotaxy. In addition, the skull-mounted tracker system allows improved anatomical localization and shorter operating time, while avoiding the complications associated with the use of rigid fixating head frames.

PMID: 28300710 [PubMed - as supplied by publisher]

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