Indication and Application of Computer-Assisted Navigation in the HURS Craniofacial Unit: 2 Years’ Experience

Background and Objective: Surgical navigation technology was first used in neurosurgery in 1908. Since then, planning software and navigation systems have evolved and now it is possible to use 3D image data with high accuracy, increasing the range of clinical applications. We present our experience using computer-assisted navigation (CAN) for the past 2 years. Study Design and Methods: This is a retrospective review of surgical cases where CAN was used. Surgical planning was done with the iPlan (BrainLab, Munich, Bavaria, Germany) planning software. Intraoperative navigation was done with the BrainLab Kolibri navigation system. Results: Between January, 2012 and December, 2013 CAN technology was applied in 240 cases. It was used in 147 patients with neurosurgical pathologies excluding skull base, 37 skull base cases (sellar pathology, skull base tumors, fractures, and trauma sequelae), 8 craniofacial deformities, and 48 patients with midface/mandibular pathology. CAN was used for the selection of the most appropriate approach, planning of osteotomies and resection margins, intraoperative localization of critical structures, and to improve the accuracy of final reconstructions. Conclusions: The development of new software tools as easy alignment of DICOM data, atlas-based autosegmentation, mirror templates and import/export STL objects, has increased the indications of CAN other than tumor localization. The ability to simulate the surgical procedure makes our results more predictable.