Abstract
Diverse stereotactic neuro-navigation systems are used daily in neurosurgery and novel systems are continuously being developed. Prior to clinical implementation of new surgical tools, methods or instruments, in vitro experiments on phantoms should be conducted. A stereotactic neuro-navigation phantom denotes a rigid or deformable structure resembling the cranium with the intracranial area. The use of phantoms is essential for the testing of complete procedures and their workflows, as well as for the final validation of the application accuracy. The aim of this study is to provide a systematic review of stereotactic neuro-navigation phantom designs, to identify their most relevant features, and to identify methodologies for measuring the target point error, the entry point error, and the angular error (α). The literature on phantom designs used for evaluating the accuracy of stereotactic neuro-navigation systems, i.e., robotic navigation systems, stereotactic frames, frameless navigation systems, and aiming devices, was searched. Eligible articles among the articles written in English in the period 2000–2020 were identified through the electronic databases PubMed, IEEE, Web of Science, and Scopus. The majority of phantom designs presented in those articles provide a suitable methodology for measuring the target point error, while there is a lack of objective measurements of the entry point error and angular error. We identified the need for a universal phantom design, which would be compatible with most common imaging techniques (e.g., computed tomography and magnetic resonance imaging) and suitable for simultaneous measurement of the target point, entry point, and angular errors.
Highlights
In the vast majority of keyhole stereotactic neurosurgical interventions, namely biopsies, deep brain stimulation (DBS), stereoelectroencephalography (SEEG), ventricular puncture, and catheter placement, straight cylindrical non-deformable instruments are introduced into the intracranial region of interest, aiming at the planned target
We have identified relevant features and limitations of current phantom designs used in the field of robotic, frameless, and frame-based stereotactic neuronavigation
Concerning the EPE, we have identified a lack of quantitative measurement of entry point errors as one of the main issues of the current phantom designs (Table 1)
Summary
In the vast majority of keyhole stereotactic neurosurgical interventions, namely biopsies, deep brain stimulation (DBS), stereoelectroencephalography (SEEG), ventricular puncture, and catheter placement, straight cylindrical non-deformable instruments are introduced into the intracranial region of interest, aiming at the planned target. By avoiding visible vessels and critical areas within the brain while navigating through a narrow entry point (two to 30 millimeters in diameter) toward the target point ensures maximum safety and minimizes potential complications. A typical stereotactic neuro-navigation procedure consists of a preoperative, a preparation, and an operative phase. Localization in the operating theater and registration with preoperative images are performed. The targeting accuracy, which ensures the technical success of the stereotactic procedure and the patient’s safety, is of crucial importance for clinical application; it is assessed in a number of phantom and patient studies (Widmann and Bale, 2006; Lozano, 2009; Widmann et al, 2009; Cardinale et al, 2013; González-Martínez et al, 2016; Švaco et al, 2017a,b; Dlaka et al, 2018). The position of these elements should be determined by standard imaging techniques and localization devices used for preoperative imaging or by localization devices in the operating room
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
