title: Neuronavigational neuroendoscopic surgery. Frameless free-hand maneuvering of a handy rigid-rod neuroendoscope on visualized three-dimensional computerized image guidance: trajectory to the prepontine cistern in cadaver study.
abstract: BACKGROUND
  Considering the separate benefits of neuronavigation and neuroendoscopy, neuroendoscopic surgery with the aid of neuronavigation systems will play an increasingly important role in the future. Bearing this in mind, the present research project was conducted to facilitate neuronavigational neuroendoscopic surgery along the pathway to the prepontine cistern using cadaver heads.
  
  
  METHODS
  A computer-aided, frameless image-guided stereotactic navigation system and a new type of handy rigid-rod neuroendoscope were used. The ideal entry point and the safest trajectory to the prepontine cistern through the foramen of Monro were defined in two formalin-fixed cadaver heads and clinical brain MRI data. Then, maneuvering of the neuroendoscope with the aid of the neuronavigation system was performed.
  
  
  RESULTS
  Straight trajectories from the entry point to the prepontine cistern could be designed. For the registration accuracy of the tip of the neuroendoscope, the virtual image registered a mean error distance of 5.42 mm away from the reference point along the axis of vertical line. However, free-hand maneuvering enabled the neuroendoscope to be finely manipulated without damaging brain tissues. Neuroendoscopic anatomical views of the interpeduncular and prepontine cistern were also acquired.
  
  
  CONCLUSIONS
  Interactive use of free-hand maneuvering of the handy rigid-rod neuroendoscope together with frameless neuronavigation systems plot the way to true neuronavigational neuroendoscopic surgery in a safe and reliable manner. This pairing of the most recent technological neurosurgical options with better understanding of neuroendoscopic anatomy enables the neurosurgeon to acquire broader treatment options for central nervous system diseases.
authors.affiliation: Department of Neurosurgery, International Neuroscience Institute, INI, Hannover, Germany.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Nonaka
authors.forename: Shizuo
authors.initials: S
authors.lastname: Oi
authors.forename: Amir
authors.initials: A
authors.lastname: Samii
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Paterno
authors.forename: Günther C
authors.initials: GC
authors.lastname: Feigl
authors.forename: Wolf
authors.initials: W
authors.lastname: Lüdemann
authors.forename: Madjid
authors.initials: M
authors.lastname: Samii
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D044582:Neuroendoscopes; D038361:Neuronavigation / Q000379:methods*; D009493:Neurosurgery / Q000295:instrumentation* / Q000379:methods*; D013238:Stereotaxic Techniques; D013523:Surgical Equipment