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Frameless stereotactic guided neurosurgery: Clinical experience with an infrared based pointer device navigation system

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Summary

An infrared based frameless stereotactic navigation device (Easy Guide Neuro) was investigated for its clinical applicability, registration/application accuracy and limitations in a standard operating room set-up.

In a five-month period 40 frameless stereotactic procedures (23 female, 17 male, mean age 46.4, yrs range 10–83) including 36 craniotomies and 4 spinal surgery procedures were performed. Image registration, data transfer and operation planning using skin fixed fiducials (between 5–10, mean 6.6) and CCT in 12 patients/MRI in 28 patients, generally was done the day before surgery.

Clinical applicability was proven in all procedures with an additional time for pre-operative imaging and system application in the OR of 50 min mean (35–120 range). A useful registration was achieved in 39/40 patients (97.5%) with a registration accuracy of 3.4 mm (range 1.8–6.7) for brain surgery cases and 14.4 mm (6.8–25) for spine cases. This resulted in intra-operative application accuracy values for brain surgery of 4.2 mm mean (range 1–12). Enhanced registration/application accuracy values over the test period from 4.2/3.8 mm mean (Cases 1–20) up to 3.2/2 mm mean (Cases 21–40) was observed. In spinal surgery an application accuracy of 11.3 mm mean (range 5–20) was found. An intra-operative re-calibration because of system-head drift was necessary in none of the patients, nevertheless, application accuracy degradation due to brain shift was detected in every case.

In conclusion, the system allowed a time sufficient accurate frameless intra-operative localisation guidance in cavernoma, meningioma, glioma, and brain metastasis surgery. In spinal surgery, the application accuracy exceeded clinical usefulness due to high registration inaccuracy using skin markers.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Vienna Medical School, Vienna, Austria

    K. Roessler, K. Ungersboeck, W. Dietrich, M. Aichholzer, Ch. Matula, Th. Czech & W. Th. Koos

  2. Department of Neuroradiology, University of Vienna Medical School, Vienna, Austria

    K. Hittmeir

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  1. K. Roessler
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  2. K. Ungersboeck
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  3. W. Dietrich
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  4. M. Aichholzer
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  6. Ch. Matula
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  7. Th. Czech
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  8. W. Th. Koos
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Roessler, K., Ungersboeck, K., Dietrich, W. et al. Frameless stereotactic guided neurosurgery: Clinical experience with an infrared based pointer device navigation system. Acta Neurochir 139, 551–559 (1997). https://doi.org/10.1007/BF02750999

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