Pre-operative planning and intra-operative guidance in modern neurosurgery: a review of 300 cases

Operative neurosurgery has recently entered an exciting era of image guided surgery or neuronavigation and application of this novel technology is beg inning to have a significant impact in many ways in a variety of intracrani al procedures. In order to fully assess the advantages of image guided techniques over con ventional planning and surgery in selected cases, detailed prospective eval uation has been carried out during the advanced development of an optically tracked neuronavigation system. Over a 2-year period, 300 operative neuros urgical procedures have been performed with the assistance of interactive i mage guidance, as well as the development of new software applications and hardware tools. A broad range of intracranial neurosurgical procedures were seen to benefit from image guidance, including 163 craniotomies, 53 interactive stereotact ic biopsies, 7 tracked neuroendoscopies and 37 complex skull base procedure s. The most common pathological diagnoses were cerebral glioma in 98 cases, meningioma in 64 and metastasis in 23. Detailed analysis of a battery of p ostoperative questions revealed benefits in operative planning, appreciatio n of anatomy, lesion location, safety of surgery and greatly enhanced surgi cal confidence. The authors believe that image guided surgical technology, with new develop ments such as those described, has a significant role to play in contempora ry neurosurgery and its widespread adoption in practice will be realised in the near future.