Pinggera Daniel, Kerschbaumer Johannes, Bauer Marlies, Riedmann Marina, Conrad Markus, Brenner Erich, Thomé Claudius, Freyschlag Christian F
Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria; Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
World Neurosurg. 2018 Dec;120:e313-e317. doi: 10.1016/j.wneu.2018.08.059. Epub 2018 Aug 23.
Neuronavigation is widely used for intracranial neurosurgical procedures and is commonly based on the standard reference array being fixed to the headholder. Some cases require the reference array to be attached directly to the head. The aim of this cadaveric study was to compare operational accuracy of a head-mounted reference array with the standard headholder-based system.
Navigation accuracy was evaluated with 10 cadaveric specimens. Each specimen was prepared with 8 titanium microscrews that served as reference points on the external skull, and computed tomography was performed. Registration of all specimens was done using surface matching with infrared laser on three-dimensional reconstructed high-resolution computed tomography. In all 10 specimens, the head-mounted reference array and headholder-based system were compared by 10 repetitive measurements. The deviation was evaluated for each screw and compared using nonparametric Mann-Whitney U test between groups and screws. A Bland-Altman plot was generated for comparison.
A total of 1600 measurements were conducted. Mean deviation was 1.97 mm (95% confidence interval, 1.90-2.03 mm) with the head-mounted reference array and 2.10 mm (95% confidence interval, 2.04-2.18 mm) with the headholder based system. There was no significant difference between methods in 9 of 10 specimens. In 1 specimen, the head-mounted array was superior. The deviation in either method showed a significant correlation, indicating high pertinence for registration (P < 0.001).
Navigation with the head-mounted reference array demonstrated comparable accuracy to the headholder-based system and can be used without reduced accuracy. Careful registration is mandatory.
神经导航广泛应用于颅内神经外科手术，通常基于固定在头架上的标准参考阵列。有些病例需要将参考阵列直接附着在头部。本尸体研究的目的是比较头戴式参考阵列与基于标准头架的系统的操作准确性。
用10个尸体标本评估导航准确性。每个标本在颅骨外制备8个钛微螺钉作为参考点，并进行计算机断层扫描。所有标本的配准均在三维重建的高分辨率计算机断层扫描上使用红外激光进行表面匹配。在所有10个标本中，通过10次重复测量比较头戴式参考阵列和基于头架的系统。评估每个螺钉的偏差，并使用非参数曼-惠特尼U检验在组间和螺钉间进行比较。生成布兰德-奥特曼图进行比较。
共进行了1600次测量。头戴式参考阵列的平均偏差为1.97毫米（95%置信区间，1.90 - 2.03毫米），基于头架的系统的平均偏差为2.10毫米（95%置信区间，2.04 - 2.18毫米）。10个标本中有9个标本的两种方法之间无显著差异。在1个标本中，头戴式阵列更优。两种方法的偏差均显示出显著相关性，表明配准具有高度相关性（P < 0.001）。
头戴式参考阵列的导航显示出与基于头架的系统相当的准确性，并且可以在不降低准确性的情况下使用。必须进行仔细的配准。
