Quantitative comparison of cranial approaches in the anatomy laboratory: A neuronavigation based research method

Aim: To describe the development and validation of a novel neuronavigation-based method, which allows the quantification of the anatomical features that define an approach, as well as real-time visualization of the surgical pyramid. Methods: The method was initially developed with commercially-available hardware for coordinate collection (a digitizer and a frameless navigation system) and software for volume rendering; dedicated neuronavigation software (ApproachViewer, part of GTx-UHN) was then developed. The accuracy of measurements and the possibility of volumetric rendering of surgical approaches simulated in a phantom were compared among three different methods and commercially-available radiological software. In the anatomy laboratory, ApproachViewer was applied to the comparative quantitative analysis of multiple neurosurgical approaches and was used by many surgeons who were untrained for the research method. Results: The accuracy of ApproachViewer is comparable to commercially-available radiological software. In the anatomy laboratory, the method appears versatile. The system can be easily used after brief training. ApproachViewer allows for real-time evaluation and comparison of surgical approaches, as well as post-dissection analyses of collected data. The accuracy of the method depends on the navigation registration: with a 1-2 mm registration error, it is adequate for evaluation and comparison of most neurosurgical approaches. Conclusion: This new research method and software allows semi-automated visualization, quantification, and comparison of neurosurgical approaches in the anatomy laboratory.