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Abstract
ObjectIn the past, the accuracy of surface matching has been shown to be disappointing. We aimed to determine whether this had improved over the years by assessing application accuracy of current navigation systems, using either surface matching or point-pair matching.MethodsEleven patients, scheduled for intracranial surgery, were included in this study after a power analysis had shown this small number to be sufficient. Prior to surgery, one additional fiducial marker was placed on the scalp, the “target marker,” where the entry point of surgery was to be expected. Using one of three different navigation systems, two patient-to-image registration procedures were performed: one based on surface matching and one based on point-pair matching. Each registration procedure was followed by the digitization of the target marker’s location, allowing calculation of the target registration error. If the system offered surface matching improvement, this was always used; and for the two systems that routinely offer an estimate of neuronavigation accuracy, this was also recorded.ResultsThe error in localizing the target marker using point-pair matching or surface matching was respectively 2.49 mm and 5.35 mm, on average (p < 0.001). In those four cases where an attempt was made to improve the surface matching, the error increased to 6.35 mm, on average. For the seven cases where the system estimated accuracy, this estimate did not correlate with target registration error (R2 = 0.04, p = 0.67).ConclusionThe accuracy of navigation systems has not improved over the last decade, with surface matching consistently yielding errors that are twice as large as when point-pair matching with adhesive markers is used. These errors are not reliably reflected by the systems own prediction, when offered. These results are important to make an informed choice between image-to-patient registration strategies, depending on the type of surgery at hand.
Highlights
Since its introduction in the 1980s, frameless stereotaxy, or neuronavigation, has become increasingly popular and has become an integral part of intracranial surgery
Acta Neurochir (2019) 161:865–870 can be applied to the scalp, prior to image acquisition, which remain in place until they are digitized in operating room (OR) space
We present a clinical evaluation of the application accuracy of current neuronavigation systems, comparing the use of adhesive markers with that of surface matching
Summary
Since its introduction in the 1980s, frameless stereotaxy, or neuronavigation, has become increasingly popular and has become an integral part of intracranial surgery. Anatomical landmarks may be used to perform point-pair matching, they are relatively difficult to digitize accurately, not abundantly available on a human head, and those that are available are not widely distributed (ears, eyes, and nose). Acta Neurochir (2019) 161:865–870 can be applied to the scalp, prior to image acquisition, which remain in place until they are digitized in OR space. As a consequence, their use requires additional preoperative image acquisition. A cloud of randomly digitized points on the scalp is fitted to a volume rendering of the imaging data
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