There are a number of issues that remain to be tackled to improve the accuracy and delivery of neurosurgical guidance. An increasing amount of information is available to the surgeon in the operating theater, particularly from intraoperative imaging devices. This may be used to improve registration and provide information about structures beneath the available tissue surface. This becomes particularly important in the presence of tissue deformation, sometimes referred to as "brain shift".
There are several imaging devices that are routinely available to a neurosurgeon. They provide real-time information about the current position and shape of the patient. If these devices are calibrated to relate the image space to physical space, they can then be incorporated into a neuronavigation system. The simplest way that this can be achieved is to show the position of a pointer or tool in the intraoperative image.
X-ray guidance is an important part of the transsphenoidal approach. The use of X-ray images to register pre-operative CT data to the patient has been proposed for use in surgery of the head and spine. X-ray angiography may also provide useful information on current patient position.
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