Neuronavigation Improving Precision in Neurosurgeries

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NeurosurgeriesBrain tumour navigation technology provides a high-refined and improved surgical precision and reduces the extent of incision due to the accurate localisation of lesions, writes Dr Kamal Verma, Director, Neurosurgery, Asian Institute of Medical Sciences.

Neuronavigation works like a GPS for a neurosurgeon. However, precision is needed in all fields of surgery. But its importance in neurosurgery where brain and spinal cord is being operated is peerless in comparison with any other fields. Even a slightest error can be disastrous and add to serious and permanent complications.

Neuronavigation systems have been developed for image-guided neurosurgery to aid in the accurate localisation of lesions and to increase the margin of safety.

We operated a patient with a brain tumour, which was very near to the speech area on the left side of the frontal lobe. A tumour could not be seen on the surface of the brain, which was normal all around. Neuronavigation helped us to precisely localise the lesion and we were exactly on the target. Thus, complete tumour removal was done without the fear of injuring the normal brain with the constant help of navigation.

We also used navigation in a skull base tumour and in the clipping of anterior communicating artery aneurysm. In both these cases, navigation helps us to localise important vessels with accuracy and increase the speed and safety of the surgery.

The basic principle of navigation is to establish a virtual space in which a reference frame is localised. A tracker attached to a probe pointer or an instrument is then registered in relation to the reference frame. The images of the MRI or CT of the patient are then loaded on the system and the pointer can be localised on the images. Hence the system shows the pointer on the images as it is moved in the patient surgery field. The navigation systems available today give accuracy to about one to two millimeters.

Navigation is also used to mark the lesions for radiotherapy, which can be precisely delivered to the target without fixing a frame to the head; this is called frameless stereotaxy. It also has used in frameless stereotactic biopsy of deep-seated lesions. It also increased the safety in skull base surgeries, such as pituitary tumours. Accurate shunt placement in smaller ventricles can be easily done with help of navigation. It is very helpful in functional surgeries such as epilepsy surgeries.

The use of navigation has also extended to spine surgeries. In spinal surgeries, the registration has to be done after fixing a reference frame or tracker on a fixed bony landmark, such as spinous process. The main indication in spine surgery is to correctly put pedicle screws in deformities.

The advantage of navigation is accuracy and reduction in the margin of error. It also reduces the extent of incision due to correct localization.

There are concerns like intraoperative brain shift due to CSF drainage or retraction, but still, it is very advantageous to use navigation as compared to anatomical knowledge alone.

Hence, it can be concluded that Neuronavigation is an invaluable tool, which reduces the margin of error and serves as a guiding tool in the complex and precision dependent field of neurosurgery.

We at Asian Institute of Medical Sciences are always committed to excellence and keep upgrading ourselves to achieve more and more precision and best possible patient care.

We are also pleased to inform that we are starting a dedicated separate Neurosciences ICU as a further step in our endeavour to deliver the best possible healthcare.  We assure you of continuing our efforts in this direction and welcome you all to be part of this journey.

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