Technical Note & Surgical TechniqueThree-dimensional, computer simulated navigation in endoscopic neurosurgery

- Pre-operative trajectory planning is optimized with neuronavigation.
- Neuronavigation aids in localizing intraoperative pathology.
- Neuronavigation may be accurate to < 1-2 mm with no brain shift-related problems.

BackgroundIn order to address the pre- and perioperative need for visualization and prediction of patient-specific anatomy for surgical planning, endoscopic neurosurgeons have increasingly relied on computerized navigation devices to guide their surgical approaches.ObjectiveThis manuscript aims to review: 1) the use of neuronavigation in endoscopic neurosurgery for pre-operative planning, 2) the intraoperative advantages of neuronavigation in endoscopic neurosurgery, and 3) the effects of navigation guidance on operative time, registration accuracy, brain shift, and avoidance of complications. Limitations of the current neuroendoscopic navigation literature will be discussed.MethodsWe conducted a search using PubMed-MEDLINE; the keywords “stereotactic navigation AND endoscopic surgery” and “simulation AND endoscopic neurosurgery.” 36 studies were identified that addressed the use of neuronavigation in endoscopic neurosurgery. These studies were then further analyzed for topics relevant to computerized neuroendoscopy and reviewed for the purposes of this article.ConclusionThree-dimensional, frameless neuronavigation systems are useful in endoscopic neurosurgery to assist in the pre-operative planning of potential trajectories and to help localize the pathology of interest. Neuronavigation appears to be accurate to < 1-2 mm without issues related to brain shift. Further work is necessary in the investigation of the effect of neuronavigation on operative time, cost, and patient-centered outcomes.