title: From letterbox to keyhole approach for resecting intracranial lesions.
abstract: BACKGROUND
  Computer-assisted neurosurgery systems (CANS) have the ability to translate preoperative image data sets directly to the operating field and were thought to be very useful in neurosurgery. However, key questions regarding their use remain only partially addressed.
  
  
  METHODS
  To answer the doubts of the skeptics, we set up a registry of all CANS and any non-CANS procedures in our institution. The results of 354 procedures are presented in this paper.
  
  
  RESULTS
  CANS was used in 254 procedures, with a mean accuracy of 1.9 mm and a failure rate of 2.8%. Over time, the accuracy improved to 1.6 mm and failures were abolished. The CANS was most useful in anterior skull approaches and took less time in the operating room, and the patients were discharged earlier than those who underwent non-CANS procedures.
  
  
  CONCLUSIONS
  We feel that the introduction of CANS has changed our practice for the better, with significant benefits to patients, surgeons and the hospital at large, and we recommend its usage as a standard of care.
authors.affiliation: Department of Neurosurgery, Ninewells Hospital and Medical School, Dundee, UK. m.s.eljamel@dundee.ac.uk
authors.forename: M Sam
authors.initials: MS
authors.lastname: Eljamel
authors.forename: Monika
authors.initials: M
authors.lastname: Hofer
mesh_terms: D006801:Humans; D038361:Neuronavigation / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D011642:Publications / Q000706:statistics & numerical data; D012042:Registries; D015203:Reproducibility of Results; D013238:Stereotaxic Techniques; D025321:Surgery, Computer-Assisted / Q000379:methods* / Q000592:standards