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Use of intraoperative navigation guidance in suboccipital approaches
EANS Academy. Wagner A. 09/25/19; 275486; EP04087
Dr. Arthur Wagner
Dr. Arthur Wagner

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Abstract
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Background: With the standardization of midline and retrosigmoid craniotomies and orientation to anatomical landmarks, the use of an optical navigation system has been regarded redundant. As suggested by literature and in our authors' experience, relevant landmarks may show significant variation and thus misguide the surgeon. We therefore aimed to investigate the applicability and utility of intraoperative navigation for midline and retrosigmoid craniotomies.
Methods: Patients undergoing elective surgery for lesions of the posterior fossa between July 2018 and January 2019 were randomized to a standardized craniotomy or a navigated craniotomy (Brainlab®) for median suboccipital and retrosigmoid approaches. Comparisons of surgical outcome, operative times, and complication rates including sinus laceration were conducted.
Results: A total of 25 patients were randomized with a mean age of 65 years. Most common diagnoses were cerebellar metastasis (35 %), vestibular schwannoma and cerebellar bleeding (15 % each). Half of all retrosigmoid craniotomies (16 total) and 44.4 % of median suboccipital craniotomies (9 total) were navigated. Subgroups of navigated and standardized craniotomies were well balanced in terms of age (p = 0.572), use of anticoagulants (p = 0.865) and operated entity (p = 0.816). Cut to suture time was significantly shorter in the navigated subgroup for both the retrosigmoid (-73 minutes; p = 0.043) and the median suboccipital approaches (-97; p = 0.031), whereas installation and registration time for the navigation system took up a mean 6 minutes and did not significantly prolong surgical prep time (p = 0.231). No sinus laceration occurred in the navigated subgroup in contrast to 3 in the other.
Conclusions: The use of a navigation system for posterior fossa surgery is superior to sole adherence to established landmarks without necessitating extensive preparation time in the surgical theatre and reduces risk of sinus laceration.
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