The virtual operating field: How image guidance became integral to microneurosurgery

Abstract

In neurosurgery, layers of soft tissue, bone, and parenchyma conceal vital structures, landmarks, and the targeted lesion. Guiding an approach to a lesion with the help of computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound images of the anatomy of a patient enables avoidance of accidental damage and the defi nition of a clear surgical corridor in individually uncharted territory. Today, surgical image guidance based on three-dimensional volumetric data has become part of the routine in most neurosurgical centres around the world. At the same time, there is a concurrent trend in medical disciplines toward augmenting interventions by virtual reality, the envisioned ideal being a virtual stereoscopic view on the surgical fi eld and beyond before the fi rst cut and throughout the operation [ 18, 27, 39 ]. Image-based, stereoscopic virtual reality models are used to plan surgical procedures and for teaching purposes in neurosurgery and temporal bone dissection [ 15, 21, 24, 27, 36, 38, 42, 45 ]. However, image guidance in neurosurgery, synonymously termed “neuronavigation”, has yet to become an integral part of most neurosurgical procedures. While this would be desirable considering the need to anticipate functional and morphological obstacles in the surgical path in individual cases, there are a number of prerequisites that will have to be met before navigation in neurosurgery will come to be seen as ordinary as navigation in today‘s automobiles. This chapter briefl y explores the history and current development in the fi eld and offers an outlook into the future of neurosurgical image guidance.