The silent loss of neuronavigation accuracy: a systematic retrospective analysis of factors influencing the mismatch of frameless stereotactic systems in cranial neurosurgery

Stieglitz, Lennart; Fichtner, Jens; Andres, Robert; Schucht, Philippe; Krähenbühl, Anna Katharina; Raabe, Andreas; Beck, Jürgen (2013). The silent loss of neuronavigation accuracy: a systematic retrospective analysis of factors influencing the mismatch of frameless stereotactic systems in cranial neurosurgery. Neurosurgery, 72(5), pp. 796-807. Hagerstown, Md.: Lippincott Williams & Wilkins 10.1227/NEU.0b013e318287072d

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BACKGROUND Neuronavigation has become an intrinsic part of preoperative surgical planning and surgical procedures. However, many surgeons have the impression that accuracy decreases during surgery. OBJECTIVE To quantify the decrease of neuronavigation accuracy and identify possible origins, we performed a retrospective quality-control study. METHODS Between April and July 2011, a neuronavigation system was used in conjunction with a specially prepared head holder in 55 consecutive patients. Two different neuronavigation systems were investigated separately. Coregistration was performed with laser-surface matching, paired-point matching using skin fiducials, anatomic landmarks, or bone screws. The initial target registration error (TRE1) was measured using the nasion as the anatomic landmark. Then, after draping and during surgery, the accuracy was checked at predefined procedural landmark steps (Mayfield measurement point and bone measurement point), and deviations were recorded. RESULTS After initial coregistration, the mean (SD) TRE1 was 2.9 (3.3) mm. The TRE1 was significantly dependent on patient positioning, lesion localization, type of neuroimaging, and coregistration method. The following procedures decreased neuronavigation accuracy: attachment of surgical drapes (DTRE2 = 2.7 [1.7] mm), skin retractor attachment (DTRE3 = 1.2 [1.0] mm), craniotomy (DTRE3 = 1.0 [1.4] mm), and Halo ring installation (DTRE3 = 0.5 [0.5] mm). Surgery duration was a significant factor also; the overall DTRE was 1.3 [1.5] mm after 30 minutes and increased to 4.4 [1.8] mm after 5.5 hours of surgery. CONCLUSION After registration, there is an ongoing loss of neuronavigation accuracy. The major factors were draping, attachment of skin retractors, and duration of surgery. Surgeons should be aware of this silent loss of accuracy when using neuronavigation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Stieglitz, Lennart; Fichtner, Jens; Andres, Robert; Schucht, Philippe; Krähenbühl, Anna Katharina; Raabe, Andreas and Beck, Jürgen

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0148-396X

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Nicole Söll

Date Deposited:

13 Nov 2013 15:22

Last Modified:

26 Jun 2014 16:22

Publisher DOI:

10.1227/NEU.0b013e318287072d

PubMed ID:

23334280

URI:

https://boris.unibe.ch/id/eprint/39245

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