Neuronavigation without rigid pin fixation of the head in left frontotemporal tumor surgery with intraoperative speech mapping.
OBJECTIVE
Intraoperative speech mapping has evolved into the "gold standard" for neurosurgical removal of lesions near the language cortex. The integration of neuronavigation into a multimodal protocol can improve the reliability of this type of operation, but most systems require rigid fixation of the patient's head throughout the operation. This article describes and evaluates a new noninvasively attached sensor-based reference tool, which can replace rigid pin fixation of the patient's head during awake craniotomies.


METHODS
The attachment technique and the resulting application accuracy were investigated under clinical conditions in 13 patients undergoing awake craniotomy with intraoperative mapping of cortical language sites.


RESULTS
Spatial information was used for updating the image guidance by continuously adjusting the image planes relative to the position of the patient's head. The mean registration error achieved with this technique was 1.53 +/- 0.51 mm (fiducial registration error +/- standard deviation). The system's median application accuracy between dura opening and closure ranged from 0.83 to 1.85 mm (position error).


CONCLUSIONS
The use of a reference sensor can replace uncomfortable pin fixation of the patient's head during navigation-supported awake craniotomies. Application accuracy is not affected by repositioning of the patient or by unavoidable head movements. Thus, this technique enables full exploitation of the benefits of navigation in a multimodal operative protocol without the need to rigidly fix the patient's head.
Suess
Olaf
O
Department of Neurosurgery, Charité-Campus Benjamin Franklin, Berlin, Germany. olaf.suess@charite.de
Picht
Thomas
T
Kuehn
Bjoern
B
Mularski
Sven
S
Brock
Mario
M
Kombos
Theodoros
T
D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000295:instrumentation* / Q000379:methods; D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005625:Frontal Lobe / Q000473:pathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007806:Language Disorders / Q000209:etiology / Q000517:prevention & control; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D038361:Neuronavigation / Q000295:instrumentation* / Q000379:methods; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery*; D014705:Verbal Behavior; D014851:Wakefulness