title: Perspectives and limitations of image-guided neurosurgery in pediatric patients.
abstract: BACKGROUND
  Progress in image-guided neurosurgery, and specifically in computer-assisted frameless navigation techniques and the application of robotic systems, has brought about many changes in the way we approach and treat pathologies involving the adult and pediatric central nervous system (CNS). Nevertheless, children are a patient group with special demands, in whom image-guided surgical techniques have certain limitations. In this article we address the common problem of registration accuracy in image-guided neurosurgery and assess both the reliability and the potential of ultrasound-based neuronavigation and robot-assisted neuroendoscopy in pediatric patients.
  
  
  RESULTS
  We present our experience with new referencing and tracking techniques adapted to the needs of the pediatric patient. In addition, advantages and limitations of a 3D real-time ultasonography-based navigation system are demonstrated. Finally, we describe our experience with robot-assisted neuroendocopy and discuss the possible implications of the technique for the future.
  
  
  CONCLUSIONS
  Image-guided techniques in pediatric neurosurgery are valuable tools and may open up new perspectives in the future. From our point of view, these tools enhance both intellectual and manual surgical skills, which does not mean that they should be considered as a replacement for such skills.
authors.affiliation: Department of Neurosurgery, Albert Ludwig University of Freiburg, Breisacherstrasse 64, 79106, Freiburg im Breisgau, Germany. vvougio@nz.ukl.uni-freiburg.de
authors.forename: Vassilios I
authors.initials: VI
authors.lastname: Vougioukas
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hubbe
authors.forename: Albrecht
authors.initials: A
authors.lastname: Hochmuth
authors.forename: Nils C
authors.initials: NC
authors.lastname: Gellrich
authors.forename: Vera
authors.initials: V
authors.lastname: van Velthoven
mesh_terms: D000293:Adolescent; D000328:Adult; D002493:Central Nervous System Diseases / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D044583:Neuroendoscopy; D009493:Neurosurgery / Q000379:methods*; D010372:Pediatrics; D012371:Robotics; D025321:Surgery, Computer-Assisted; D014463:Ultrasonography / Q000379:methods