title: Systematic review of the efficacy in seizure control and safety of neuronavigation in epilepsy surgery: The need for well-designed prospective studies.
abstract: OBJECTIVE
  To evaluate the efficacy of surgery with neuronavigation compared to conventional neurosurgical treatment of epilepsy in terms of safety and seizure outcomes and to assess the quality of the evidence base of neuronavigation in this clinical context.
  
  
  METHODS
  Systematic review using the electronic databases of Cochrane, CRD, PubMed, Embase, SciELO and LILACS in Portuguese, English and Spanish. The [MeSH] terms included "epilepsy" and "neuronavigation".
  
  
  METHODS
  Studies assessing surgery with neuronavigation for the surgical treatment of epilepsy or brain injuries associated with epileptic seizures.
  
  
  RESULTS
  We identified 28 original articles. All articles yielded scientific evidence of low quality. Outcome data presented in the articles identified was heterogeneous and did not amount to compelling evidence that epilepsy surgery with neuronavigation produces higher rates of seizure control, a reduced need for reoperations, or lower rates of complications or postoperative neurological deficits.
  
  
  CONCLUSIONS
  We were unable to find any publications providing convincing evidence that neuronavigation improves outcomes of epilepsy surgery. Whilst this does not mean that neuronavigation cannot improve neurosurgical outcomes in this clinical setting, well-designed research studies evaluating the role of neuronavigation are urgently needed.
authors.affiliation: Nuclear Medicine & Molecular Imaging Section, Image Science and Medical Physics Center, Internal Medicine Department and Post-graduation Program, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Daniele Kanashiro
authors.initials: DK
authors.lastname: Sonvenso
authors.affiliation: Nuclear Medicine & Molecular Imaging Section, Image Science and Medical Physics Center, Internal Medicine Department and Post-graduation Program, University of São Paulo, Ribeirão Preto, Brazil; Bioengineering Interunits Program, São Carlos School of Engineering, University of São Paulo, São Carlos, Brazil.
authors.forename: Emerson Nobuyuki
authors.initials: EN
authors.lastname: Itikawa
authors.affiliation: Clinical Surgery Postgraduate Program, Department of Surgery and Anatomy, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Marcelo Volpon
authors.initials: MV
authors.lastname: Santos
authors.affiliation: Nuclear Medicine & Molecular Imaging Section, Image Science and Medical Physics Center, Internal Medicine Department and Post-graduation Program, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Leonardo Alexandre
authors.initials: LA
authors.lastname: Santos
authors.affiliation: Nuclear Medicine & Molecular Imaging Section, Image Science and Medical Physics Center, Internal Medicine Department and Post-graduation Program, University of São Paulo, Ribeirão Preto, Brazil; Bioengineering Interunits Program, São Carlos School of Engineering, University of São Paulo, São Carlos, Brazil.
authors.forename: Ana Carolina
authors.initials: AC
authors.lastname: Trevisan
authors.affiliation: Epilepsy Surgery Center (CIREP), Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Marino Muxfeldt
authors.initials: MM
authors.lastname: Bianchin
authors.affiliation: Nuclear Medicine & Molecular Imaging Section, Image Science and Medical Physics Center, Internal Medicine Department and Post-graduation Program, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Felipe Arriva
authors.initials: FA
authors.lastname: Pitella
authors.affiliation: Nuclear Medicine & Molecular Imaging Section, Image Science and Medical Physics Center, Internal Medicine Department and Post-graduation Program, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Mery
authors.initials: M
authors.lastname: Kato
authors.affiliation: Clinical Surgery Postgraduate Program, Department of Surgery and Anatomy, University of São Paulo, Ribeirão Preto, Brazil; Epilepsy Surgery Center (CIREP), Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Carlos Gilberto
authors.initials: CG
authors.lastname: Carlotti
authors.affiliation: The Center for Interdisciplinary Research on Applied Neurosciences - NAPNA - University of São Paulo (USP), Brazil.
authors.forename: Geraldo Filho
authors.initials: GF
authors.lastname: Busatto
authors.affiliation: Epilepsy Surgery Center (CIREP), Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Tonicarlo Rodrigues
authors.initials: TR
authors.lastname: Velasco
authors.affiliation: Nuclear Medicine & Molecular Imaging Section, Image Science and Medical Physics Center, Internal Medicine Department and Post-graduation Program, University of São Paulo, Ribeirão Preto, Brazil; The Center for Interdisciplinary Research on Applied Neurosciences - NAPNA - University of São Paulo (USP), Brazil.
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Santos
authors.affiliation: Epilepsy Surgery Center (CIREP), Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: João Pereira
authors.initials: JP
authors.lastname: Leite
authors.affiliation: Epilepsy Surgery Center (CIREP), Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Américo Ceiki
authors.initials: AC
authors.lastname: Sakamoto
authors.affiliation: Clinical Surgery Postgraduate Program, Department of Surgery and Anatomy, University of São Paulo, Ribeirão Preto, Brazil; Epilepsy Surgery Center (CIREP), Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Hélio Rubens
authors.initials: HR
authors.lastname: Machado
authors.affiliation: Health Technology Assessment Center of the Clinical Hospital, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Altacílio Aparecido
authors.initials: AA
authors.lastname: Nunes
authors.affiliation: Nuclear Medicine & Molecular Imaging Section, Image Science and Medical Physics Center, Internal Medicine Department and Post-graduation Program, University of São Paulo, Ribeirão Preto, Brazil; Health Technology Assessment Center of the Clinical Hospital, University of São Paulo, Ribeirão Preto, Brazil; Bioengineering Interunits Program, São Carlos School of Engineering, University of São Paulo, São Carlos, Brazil; The Center for Interdisciplinary Research on Applied Neurosciences - NAPNA - University of São Paulo (USP), Brazil. Electronic address: lwichert@fmrp.usp.br.
authors.forename: Lauro
authors.initials: L
authors.lastname: Wichert-Ana
mesh_terms: D018849:Controlled Clinical Trials as Topic; D004827:Epilepsy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D038361:Neuronavigation; D012196:Review Literature as Topic; D012640:Seizures / Q000503:physiopathology / Q000601:surgery*
keywords: Neuroimaging; Neurological deficits; Outcome; Resection; Risk