Cranial neuronavigation in neurosurgery: Assessment of usefulness in relation to type and site of pathology in 284 patients

Objective: Neuronavigation improves intraoperative topographical orientatio n in neurosurgery. We wanted to better define the practical value of this t echnique in relation to the pathology operated on and the types of cranial surgery that profit the most from it. Methods: Usefulness, interactive use and probably preventive effect of neuronavigation in cranial neurosurgery w ere assessed in a consecutive series of 284 patients on the basis of questi onnaires with two- or five-point scale ratings by different neurosurgeons. Results: Neuronavigation was most helpful in tumors of the hemispheres (par ticularly the central area) not visible at the cortical surface or resembli ng normal white matter, and in endoscopic procedures within small ventricle s or cysts with non-translucent walls or when vision was blurred by cloudy CSF. In the same pathologies and surgical procedures, the device was intera ctively used, taking advantage of the specific possibilities of interactive image-guided neurosurgery. A probably preventive effect of neuronavigation was noted in operations in eloquent areas; highest scores were given for i ntraaxial tumors of the central region. The subjective assessments of usefu lness, interactive use or preventive effect were not dependent on the invol vement of the neurosurgeons in this study. Conclusion: We recommend this te chnique in resecting tumors in eloquent areas of the cortex or white matter , in approaching deep-seated processes not visible at the cortical surface, in defining borders of tumors resembling normal brain tissue, and in guidi ng endoscopes where ventricles are small or vision is blurred. This recomme ndation applies to any neurosurgeon familiar with the technique and managin g neurosurgical cases requiring precise topographical orientation where nor mal anatomic landmarks are missing.