Neuronavigation, also known as image-guided surgery, involves using brain imaging technology during brain surgery. It allows the surgeon to pinpoint the target area of the brain, keep track of where the instruments are in relation to the different brain structures, and avoid causing damage to healthy tissue with the surgical instruments. This means that a smaller incision is needed so recovery is easier, and also means that the operation is shorter and less dangerous for the patient.
In most brain surgeries, the patient will be under general anesthesia and so will not be conscious or able to feel pain. The hair on the part of the skull over the area in need of surgery will be shaved and the skin cleansed. A surgeon will cut a flap of scalp to expose the bone, and then cut a flap of bone out so that he or she can access the brain. In the majority of surgeries, the flap of bone and scalp will be replaced once the surgery is over, but some patients will receive a metal or other material plate over the hole.
Increasingly, neurosurgeons are using minimally invasive techniques in brain surgery. This includes using smaller instruments and opening smaller holes in the skull. Neuronavigation systems allow the surgeon to see what he or she is doing without having to remove a large part of the skull. Surgery can then be performed through an opening only large enough to admit the instruments.
The structures of the brain are very delicate and complex, and can easily be accidentally damaged by the surgical instruments. Damage can be devastating for the patient if even a small portion of healthy tissue is injured, with possible consequences including memory loss, speech or motor difficulties, personality change, various intellectual deficiencies, coma, and death. Neuronavigation helps to prevent these consequences by increasing the accuracy of the surgery, allowing doctors to pinpoint the target area.
Neuronavigation is used both in the surgical theater and for advance procedure planning. Each person's brain is a little bit different, and the ability to plan the surgery while looking at an individual patient's brain is invaluable to surgeons. The surgeon can try different approaches to access a deep tumor, for example, before the patient's skull is open. Following the plan usually leads to a quicker and less stressful surgery for both the patient and the neurosurgeon.
Brain surgeons are guided by neuronavigation, and it is not a replacement for any aspect of brain surgery. Choosing a competent surgeon is still critically important for a good neurosurgery outcome. Surgeons also need experience working with neuronavigation, since both the image on the monitor and the physical situation must be kept track of simultaneously, requiring concentration and a careful approach.