Principles and Practice of Image-guided Neurosurgery

Image-guided neurosurgery depends on the registration of pre-operatively acquired images with the physical space of the patient on the operating table. With the aid of a computer workstation and a tracking device, the neurosurgeon is able to obtain a three-dimensional, visual, real-time image of a registered probe in relation to the patient’s anatomy and pathology. Image guidance facilitates localization of target structures and their anatomical relations and allows the pre-operative planning of the ideal, minimal risk, trajectory. It has become a useful tool in the surgical management of intracranial tumors and has also been applied to arteriovenous malformations, pericallosal aneurysms, epilepsy surgery, intracranial endoscopy and spinal surgery. The principal problem is the system’s dependence on preoperatively acquired images; perioperative updating of these images by perioperative magnetic resonance imaging overcomes this difficulty.