title: Advanced cranial navigation.
abstract: BACKGROUND
  Cranial surgical navigation is most commonly performed by registration with fiducial markers, optic tracking, and intermittent pointer-based application.
  
  
  OBJECTIVE
  To assess the accuracy and applicability of an advanced cranial navigation setup.
  
  
  METHODS
  Continuous electromagnetic instrument navigation was used in 136 neurosurgical cases with a standard navigation system. A phantom head in an intraoperative magnetic resonance imaging environment was used to compare the accuracy of the advanced and standard navigation setups.
  
  
  RESULTS
  A navigated suction device was used in 71 cases of intracranial tumor surgery and 46 cases of endoscopic transsphenoidal surgery. The ventriculoscope was navigated in 6 cases and the stereotactic biopsy needle in 4 cases. Electromagnetic tracking was used for catheter placement in 9 cases. The learning curve comprised 6 of the 136 cases during the first month of application. No significant difference was observed at the intracranial target points between the standard navigation setup using optic tracking, fiducial marker registration, and pointer and the advanced navigation setup with electromagnetic tracking, surface-based registration, and navigation of a field-detecting stylet in a standard metal suction tube when performed outside the 5-G line of the 3.0-T intraoperative magnetic resonance imaging.
  
  
  CONCLUSIONS
  Continuous instrument navigation is the prerequisite for seamless integration of navigation systems into the neurosurgical operating workflow. Our data confirm that the application of preoperative imaging, surface-merge registration, and continuous electromagnetic tip-tracked instrument navigation may provide such integration without a significant reduction in accuracy compared with standard navigation.
authors.affiliation: Department of Neurosurgery, Medical University Vienna, Austria.
authors.forename: Ayguel
authors.initials: A
authors.lastname: Mert
authors.forename: Liu Shi
authors.initials: LS
authors.lastname: Gan
authors.forename: Engelbert
authors.initials: E
authors.lastname: Knosp
authors.forename: Garnette R
authors.initials: GR
authors.lastname: Sutherland
authors.forename: Stefan
authors.initials: S
authors.lastname: Wolfsberger
mesh_terms: D016080:Arachnoid Cysts / Q000473:pathology / Q000601:surgery; D001707:Biopsy, Needle; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D003243:Consciousness; D006804:Ergonomics; D057918:Fiducial Markers; D019416:Head Movements; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000592:standards; D059346:Magnets; D016343:Monitoring, Intraoperative / Q000379:methods / Q000592:standards; D044583:Neuroendoscopy / Q000295:instrumentation* / Q000379:methods*; D038361:Neuronavigation / Q000379:methods* / Q000592:standards*; D019047:Phantoms, Imaging; D011140:Polyurethanes; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery; D013647:Task Performance and Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000592:standards
chemical_list: D011140:Polyurethanes