No neurosurgeon needs to be reminded of the challenge posed by the need to identify and localize accurately structures on the brain surface and within the brain that are critical for neurological function, and which may be indistinguishable visually from adjacent, non-critical structures. Indeed, perhaps a frequent - but usually unspoken - question from a patient to their surgeon is: "How are you going to find your way around in there?". The practice of safe and effective neurosurgery rightly places increasing emphasis on the need to minimize risk. Reliable navigation in and around the brain, and the localization of surgical targets, are important contributions to the achievement of this goal.
A variety of technical approaches are available to the surgeon, and although much developmental work has taken place in several centers, involving collaborations between physicists, software engineers and surgeons, the commercial market has matured recently. Surgeons have some degree of choice of systems and technical solutions, and have a duty to understand both the nature of the procedures that contribute to neuronavigation, and the factors that determine reliability and accuracy. It is also important that evolution of the technology is driven not by technical advances but by specifications influenced primarily by surgeons.
In this chapter we shall set out the principles and methodological approaches that underlie the concept of image-guided neurosurgery, review and assess the state of development of applications to specific surgical procedures, and briefly consider potential future developments.
We believe that the term "stereotaxy" should be confined strictly to procedures in which a stereotactic frame is used, and that the term "image-guided neurosurgery" is a much more appropriate description of the subject; thus "frameless stereotaxy" is inappropriate, not least because it implies a degree of accuracy that is available only in frame-based systems.
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