Advanced Neuronavigation and Image-Guided Interventions in Neurosurgery

Volker Seifert MD, PhD

Department of Neurosurgery
Johann Wolfgang Goethe University
Frankfurt/ Mai, Germany

Abstract: The development of image-guided neurosurgery
represents a substantial improvement in the microsurgical
treatment of tumors, vascular malformations and other
intracranial lesions.In this context, since the beginning of the
nineties, the rapid development of navigational devices have
provided the neurosurgeon with an unprecedented degree of
surgical accuracy and precision for the planning as well as
performance of a large variety of neurosurgical
procedures.With the availability of higly sophisticated
computer programms as well as advanced preoperative image
data it is now also possible to implement data derived from
functional MRI examinations into the intraoperative
neuronavigational procedure, adding considerably to the
safety of resective tumor or vascular surgery directly adjacent
to eloquent brain regions. Additional applications of
intraoperative neuronavigation incorporate MRI derived
images from cortico-spinal tracts as well three dimensional
reconstruction of complex vascular structures. The current
possibilies of state-of-the art neuronavigation as well as the
future perspectives of neuronavigation including the
implementation of robotic technologies will be presented
However, despite the wide applicability and many
fascinating aspects of image guided navigation systems,
its major drawback lies in the fact, that all these
neuronavigational systems use image data, aqcuired
preoperatively, on which the planning of the operative
procedure as well as its intraoperative performance is
based. As dynamic changes of the intracranial contents
(brain shift) regularly occur during surgery the surgeon
is faced with a continously changing intraoperative field
for which the peroperative acquired data don not
provide any on-line information. It is therefore clear,
that only intraoperatively acquired images, will provide
the neurosurgeon with the on-line information he needs
to perform real intraoperative image.guided surgery.
Over the last ten years intraoperative MRI using
different forms of field strenghs has evolved as a higly
technical method for exact real-time intraoperative
imaging. Based on the experiences of the author with
this technology, the development of MRI guided
neurosurgery will be shortly reviewed, current
applications of MRI guided surgery will be presented
and future perspectives of intraoperative MRI ,
especially in a combination of sophisticated
neuronavigation and high-field MRI will be outlined.

O. Dössel and W.C. Schlegel (Eds.): WC 2009, IFMBE Proceedings 25/VI, p. 366, 2009.
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