| Pitfalls of the Neuronavigation-guided Brain Surgery |
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Jong Chul Chung, Sung Sam Jung, Seong Min Kim, Seung Young Chung, Ki Seok Park, Moon Sun Park, Han Kyu Kim |
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Department of Neurosurgery, Eulji University College of Medicine, Daejeon, Korea |
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| Abstract |
Objective
Modern neurosurgery has undergone a revolution in the past decade with the introduction and wide spread adoption of frameless stereotactic technology. Optimal use of these technologies, however, requires an understanding of their principles and potential pitfalls. The purpose of this study is not only revealment of pitfalls and mistakes but also suggestion of methods minimizing errors of neuronavigation-guided brain surgery.
Methods
The authors reviewed navigation assisted brain surgery from 2004 to 2006. There were brain tumor (280), AVM (4), cavernous malformation (7) surgery and biopsy or catheter procedure (25). We analysed pitfalls of neuronavigation system in relation to stage of operation which were taking images with fiducial marker, surgical positioning, registration, intradural procedures and problems of pointing device.
Results
The problems on stage of image equipment is position of fiducial marker. Fiducial should be attached to fixed and unmovable scalp or skin and position of patient during CT or MRI scanning was good to be same as operative position as possible. Patient position in operation room should be simple and fixed firmly because of minimizing the errors of real time interpretation and errors by change of position. On the stage of registration, you should point to imaginary center of fiducial with consideration of exact location of fiducial before positioning, because the position of fiducial might moved after head fixation. Pitfalls of intradural procedure was already well known to us. Brain shift with decompression of mass or cyst should be kept in mind always. At last, it is very important to master handling of biopsy device or catheter insertion device and calibration system.
Conclusion
Neuronavigation-guided brain surgery is developed more and more with new technology. But neurosurgeons must keep in mind a few pitfalls and understand principles in using neuronavigation system and also make efforts to master exact surgical anatomy. The authors have recommended some techniques which lessen the system errors. Another studies should be continued to overcome pitfall of neuronavigation system. |
| Key Words:
Neuronavigation, Brain surgery, Pitfalls, Errors. |
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