Neuro-navigation began in 1990s and has adapted to new neuroimaging technologies, to transfer information in operating room for 3-D localization, real time neuro-monitoring robotics and new and better algorithms to handle data via more sophisticated computer technologies. It gained popularity during the 1940s, particularly in Germany, France and the US, with the development of surgery for the treatment of movement disorders.
Initially, anterior craniofacial resection was associated with significant morbidity. Ketcham and colleagues reported an 80% morbidity and a 7% mortality rate in their early series [7
]. With the development of new surgical techniques, especially reconstructive methods of the skull base, and improved perioperative care, morbidity and mortality rates have been reduced to 30–50% [8
Neuro-navigation techniques may help delineating tumor margins for tailored resection and also provide assistance in spatial orientation as anatomical landmarks are frequently lost due to tumor destruction. Image guided surgery at the skull base. The use of intraoperative navigation for surgery of the anterior skull base has been mainly described by ENT or maxillofacial surgeons in the past, [9
] and are already well established in neurosurgery [10
The contribution of navigated surgery in various anterior skull base lesions exposed through a broad subcranial, subfrontal approach was evaluated in a recent report [11
]. The authors concluded, neuro-navigation was helpful for anterior skull base tumors especially for the exposure of tumor extensions located at the parasellar sphenoclival complex with concomitant distortion of anatomic landmarks. The suitability and usefulness of intraoperative image guided surgery of the anterior skull base in patients with tumors or trauma was evaluated in other studies. They stated that navigation reliably allowed to visualize the extent of tumor configuration and risk zones [12
]. Despite the destruction of anatomical landmarks related to tumor invasion or intraoperative bone removal, neuro-navigation proved to be helpful allowing more radical resection associated with less morbidity in a series of 11 patients. Another report emphasized that navigation can provide sufficient precision and reproducibility in frontal skull base surgery and may help to optimize the surgical corridor in transfrontal approaches and the reconstruction procedure for a good functional and cosmetic result [9
Our experience with neuro-navigation to guide surgical resection of upper clival tumors and JNA is through a Lefort I access craniofacial. Regarding the lavish surgical corridor through the Lefort I access osteotomy, spatial orientation becomes somewhat more easier and the contribution of image guided surgery is being appreciated better as with smaller surgical approaches like lateral rhinotomy. Compared to image guided surgery in intracerebral lesions, its application at the skull base as used in our experience is less influenced by intraoperative shifts of relevant anatomic structures.
Image guided surgery rapidly is becoming a well accepted technique in craniofacial surgery. It is still a matter of debate, however, whether the use of image guidance indeed contributes to improved safety and better outcome of surgery. In the present series, morbidity and mortality rates were low. Future studies may provide additional data on long-term results and long-term benefit of neuro-navigation in the field of craniofacial and skull base surgery.