Neurosurgical craniotomy localization using a virtual reality planning system versus intraoperative image-guided navigation.
OBJECTIVE
Accurate craniotomy placement is essential for frameless neuronavigation in minimally invasive neurosurgery. A craniotomy using virtual reality (VR) can be as accurate as neuronavigation.


METHODS
We prospectively enrolled 48 patients that underwent minimally invasive cranial procedures planned using VR, followed by neuronavigation. First, craniotomies were planned using VR derived measurements. Second, frameless neuronavigation was applied to define the craniotomy. The locations of these paired craniotomies were compared. A correctly placed craniotomy was defined as one that enabled the surgeon to totally remove the pathology without need to enlarge the craniotomy intraoperatively.


RESULTS
Using VR, the size and the position of the craniotomy were measured correctly in 47 of 48 cases (98%). In 44 of 48 cases (92%), neuronavigation identified the craniotomy site correctly. In cases where neuronavigation failed, minimally invasive surgery was successfully completed using preoperative VR surgery planning. No statistically significant difference was found between craniotomy localization using VR surgery planning or standard frameless neuronavigation (p = 0.36).


CONCLUSIONS
The craniotomy for minimally invasive neurosurgical procedures can be identified accurately using VR surgery planning or neuronavigation. In cases of neuronavigation failure, VR surgery planning serves as an effective backup system to perform a minimally invasive operation.
Stadie
Axel T
AT
Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstrasse 1, 55101 Mainz, Germany. Axel.Stadie@me.com
Kockro
Ralf A
RA
Serra
Luis
L
Fischer
Gerrit
G
Schwandt
Eike
E
Grunert
Peter
P
Reisch
Robert
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D016343:Monitoring, Intraoperative / Q000379:methods*; D038361:Neuronavigation / Q000295:instrumentation* / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D013238:Stereotaxic Techniques; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014584:User-Computer Interface; D055815:Young Adult
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