Cranial 3D Neuronavigation to the Sellar Region: Our Experience and Proof of Principle

Background/Objectives: Neuronavigation has been a mainstay of neurosurgery since several decades. A drawback of conventional neuronavigation systems is the necessity of focusing on three 2D images to determine one´s spatial position in the OP field. A possible solution is to integrate the data into a single holographic 3D-image. Until recently, this required the use of 3D-glasses in the OR, which was unpractical and cumbersome. We applied a neuronavigation-linked autostereoscopic glass-free 3D-monitor for intraoperative image guidance in the sellar region, and present our experience as a proof of principle.

Materials/Methods: We have tested 3D neuronavigation in 10 patients with sellar and suprasellar pituitary tumors. The operative planning was conducted BrainLab Colibri navigation system using CT and MR imaging. The image datasets were processed by the Clariti 3D-system to produce a 3D-rendering of the images. The two systems were then linked and synchronized. The operations were conducted through a transsphenoidal approach utilizing a pituitary endoscope.

Results: We found the 3D navigation intuitive, simple and safe to use. The rendered images mirrored the 3D anatomy and spatial configuration accurately. Our surgeons reported a steep learning curve and mastered the new system intuitively. We had to abandon the 3D neuronavigation in 1 case (n = 1, 10%) due to technical difficulties. We have found the 3D navigation a good supplement to the conventional 2D tri-plane navigation, especially in spatial orientation. The main disadvantages we found were the additional planning and effort needed to render the images in the 3D system.

Conclusions: We experienced a relatively low failure rate (n = 1) with the 3D navigation system. With further development of the 3D system, it could eventually replace conventional triplane navigation due to its intuitive use. 3D-neuronavigation could be particularly advantageous in cases with tumor recurrence, where ‘normal’ anatomy is altered through scarring. 3D-rendering could additionally be helpful in preoperative planning The additional planning and export/synchronization procedures are the main disadvantages we encountered; merging the navigation system with the 3D-monitor in a single system could alleviate this problem.