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

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