title: Frameless and Maskless Stereotactic Navigation with a Skull-Mounted Tracker.
abstract: OBJECTIVE
  In this series, we present 3 cases that show the use of a skull-mounted tracker for image-guided navigation for anterior skull base surgery and ventricular catheter placement procedures. This system obviates fiducials or face masks during the surgical procedure itself and allows for the performance of facial incisions using the Weber-Ferguson approach.
  
  
  METHODS
  Our series presents the use of a novel intraoperative navigational system that uses a skull-mounted tracker to navigated anterior skull base surgery.
  
  
  RESULTS
  We present 3 cases using this new system: 1 anterior skull base tumor removal that was operated on without a facemask for navigation and 2 ventricular catheter placement procedures.
  
  
  CONCLUSIONS
  Intraoperative image-guided navigation has revolutionized neurosurgery. It undoubtedly increases the surgeon's confidence and the perception of safety. Although fiducials and facial masks are the most widely used tools for intraoperative navigation, their use is associated with certain complications. This technique permits free movement of the head during surgery, which in turn facilitates the exposure of head and neck lesions and expedites the approach to ventricular catheter placement. Our case series shows the precision and ease of our technique, which is less time consuming and less cumbersome than the traditional frame-based stereotaxy. In addition, the skull-mounted tracker system allows improved anatomic localization and shorter operating time and avoids the complications associated with the use of rigid fixating head frames.
authors.affiliation: Departments of Neurological Surgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Fanous
authors.affiliation: Brain Tumor Center, Department of Neurosurgery, Lenox Hill Hospital, New York, NY Hofstra-Northwell School of Medicine, Manhasset, New York, USA.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: White
authors.affiliation: New York Head and Neck Institute, Department of Otolaryngology, Lenox Hill Hospital/Manhattan Eye Ear and Throat Hospital, New York, New York, USA.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Hirsch
authors.affiliation: Brain Tumor Center, Department of Neurosurgery, Lenox Hill Hospital, New York, NY Hofstra-Northwell School of Medicine, Manhasset, New York, USA.
authors.forename: Shamik
authors.initials: S
authors.lastname: Chakraborty
authors.affiliation: New York Head and Neck Institute, Department of Otolaryngology, Lenox Hill Hospital/Manhattan Eye Ear and Throat Hospital, New York, New York, USA.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Costantino
authors.affiliation: Brain Tumor Center, Department of Neurosurgery, Lenox Hill Hospital, New York, NY Hofstra-Northwell School of Medicine, Manhasset, New York, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Langer
authors.affiliation: Brain Tumor Center, Department of Neurosurgery, Lenox Hill Hospital, New York, NY Hofstra-Northwell School of Medicine, Manhasset, New York, USA. Electronic address: jboockvar@northwell.edu.
authors.forename: John A
authors.initials: JA
authors.lastname: Boockvar
mesh_terms: D000328:Adult; D001927:Brain Diseases / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008397:Masks; D038361:Neuronavigation / Q000295:instrumentation*; D019291:Skull Base / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Face mask; Frameless navigation; Skull-mounted tracker