title: Neurosurgical craniotomy localization using a virtual reality planning system versus intraoperative image-guided navigation.
abstract: 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.
authors.affiliation: Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstrasse 1, 55101 Mainz, Germany. Axel.Stadie@me.com
authors.forename: Axel T
authors.initials: AT
authors.lastname: Stadie
authors.forename: Ralf A
authors.initials: RA
authors.lastname: Kockro
authors.forename: Luis
authors.initials: L
authors.lastname: Serra
authors.forename: Gerrit
authors.initials: G
authors.lastname: Fischer
authors.forename: Eike
authors.initials: E
authors.lastname: Schwandt
authors.forename: Peter
authors.initials: P
authors.lastname: Grunert
authors.forename: Robert
authors.initials: R
authors.lastname: Reisch
mesh_terms: 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
references.citation: Neurosurgery. 2009 Oct;65(4):795-807; discussion 807-8
references.pmid: 19834386
references.citation: Neurosurg Rev. 2003 Jan;26(1):53-61
references.pmid: 12520318
references.citation: Mt Sinai J Med. 2000 Sep;67(4):300-10
references.pmid: 11021780
references.citation: J Neurosurg. 2008 Feb;108(2):382-94
references.pmid: 18240940
references.citation: J Neurosurg. 2005 Sep;103(3):424-7
references.pmid: 16235672
references.citation: Neurosurgery. 2000 Jan;46(1):118-35; discussion 135-7
references.pmid: 10626943
references.citation: Acta Neurochir (Wien). 2009 May;151(5):453-63; discussion 463
references.pmid: 19319471
references.citation: Neurosurg Focus. 2009 May;26(5):E20
references.pmid: 19408999
references.citation: Minim Invasive Neurosurg. 2009 Feb;52(1):9-16
references.pmid: 19247899
references.citation: Minim Invasive Neurosurg. 2002 Mar;45(1):6-10
references.pmid: 11932817
references.citation: Stereotact Funct Neurosurg. 1993;61(2):80-95
references.pmid: 8197330
references.citation: Minim Invasive Neurosurg. 2000 Sep;43(3):124-31
references.pmid: 11108110
references.citation: Neurosurgery. 1999 Jan;44(1):97-104; discussion 104-5
references.pmid: 9894969
references.citation: Neurosurgery. 2007 Sep;61(3):564-8; discussion 568-9
references.pmid: 17881970
references.citation: Neurosurg Rev. 2003 May;26(2):73-99; discussion 100-1
references.pmid: 12962294