Abstract
Introduction: Accurate flap marking has always been a challenge for neurosurgeons during tumor surgery. The use of neuronavigation has somewhat overcome this problem by allowing the navigation of intraoperative 3D neuroanatomy of the lesion. In this study, we aim to evaluate the percentage discrepancy of tumor surface marking by experienced neurosurgeon versus neuronavigation guidance.
 Methods: This is a prospective analytical study. Initial surface marking of the tumor was done by experienced neurosurgeon on the basis of sagittal, coronal and axial Magnetic Resonance Imaging films; and later was re-marked using neuronavigation. Photographs of surface markings were taken then comparison was done by plotting marking on the standard graph paper and percentage discrepancies were calculated for every case.
 Results: Percentage discrepancy ranged from 15 % to 81 % and the mean discrepancy score was 44%.
 Conclusion: Even in experienced neurosurgeon's hand, flap marking is not always accurate and neuronavigation definitely seems to be an effective tool.
Highlights
Accurate flap marking has always been a challenge for neurosurgeons during tumor surgery
A prospective analytical study was done with an objective to calculate the discrepancy in between surface marking of an operative flap for a brain tumor surgery by an experienced neurosurgeon versus a neuronavigation guidance
Nepal PR et al.: Comparison of tumor surface marking were included in the study Initial surface marking of the tumor was done by our experienced neurosurgeon on the basis of sagittal, coronal and axial Magnetic Resonance Imaging (MRI) films; and later was remarked using neuronavigation (Medtronic Stealth Station S7 neuronavigation system)
Summary
Accurate flap marking has always been a challenge for neurosurgeons during tumor surgery. We aim to evaluate the percentage discrepancy of tumor surface marking by experienced neurosurgeon versus neuronavigation guidance. Accurate flap marking has always been a challenge for neurosurgeons during tumor surgery, especially in cases of convexity meningioma, and cortical gliomas. The use of neuronavigation has somewhat overcome this problem by helping in accurate surface marking of these lesions.[1] Many a times, in the literatures the target localizing accuracy of neuronavigation has been calculated and mean value is around
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