title: [Intraoperative navigation, with focus on the skull base].
abstract: Intraoperative navigation systems are widely used in ENT, oral and maxillofacial, and neurosurgery. The benefits of such systems have been demonstrated in various applications, including intracranial and skull base surgery. Intraoperative shift, "brain shift" and changes in anatomy caused by the surgical procedure itself impair the accuracy of navigation and represent factors limiting its application, particularly in glioma and metastatic brain surgery. For this reason, intraoperative imaging was incorporated into neurosurgery. A specific application of navigation is thus skull base surgery, where shifts are often negligible due to the bony structures in which pathologies are embedded. Development of new systems with seamless integration into the operative workflow propagated routine use of navigation in neuro- and ENT surgery. Navigation proved especially helpful in interdisciplinary surgery with pathologies located in anatomic regions where competences of different surgical disciplines overlap, as in the skull base. While this increased radicality in tumour resection, there was a high risk of morbidity. The integration of electrophysiological function monitoring served to preserve function and reduce morbidity, and has led to less invasive and radical strategies in skull base surgery. New radiosurgical methods to adjuvantly treat possible tumour remnants have also supported this development. Systems allowing resection borders to be marked in the navigational coordinates would enable direct linking of these data to radiotherapy planning and better interpretation of follow-up imaging. Navigation is thus a valuable tool supporting interdisciplinary cooperation in skull base surgery for the benefit of patients.
authors: Universitätsklinikum Ulm, Zentrum für Chirurgie, Neurochirurgische Universitätsklinik, Albert-Einstein-Allee 29, 89081, Ulm, Deutschland. rainer.wirtz@bkh-guenzburg.de.|Neurochirurgische Universitätsklinik der Universität Ulm, am Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Str. 2, 89312, Günzburg, Deutschland. rainer.wirtz@bkh-guenzburg.de.
authors: C R
authors: CR
authors: Wirtz
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D038361:Neuronavigation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D019291:Skull Base / Q000000981:diagnostic imaging / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: Computer-assisted surgery; Intraoperative neurophysiological monitoring; Neurosurgical procedures; Skull Base Surgery; Stereotaxic techniques