Neuronavigation

Neuronavigation, also known as image-guided navigation, is a medical technology that guides neurosurgical procedures and other intracranial interventions by correlating patient anatomy with preoperative or intraoperative imaging data. The system provides real-time visualization of a surgical field relative to MRI or CT scans, helping clinicians plan trajectories, localize targets, and avoid critical structures.

A typical neuronavigation setup includes a workstation linked to preoperative imaging, a tracking system (optical or electromagnetic), a patient or instrument reference frame, and hand-held or pointer instruments that are registered to image space. During registration, points or surfaces from the patient are matched to the imaging data to establish a common coordinate system. The surgeon then tracks instruments on a display as they move within the registered image, enabling precise navigation.

Neuronavigation is used in frame-based and frameless approaches. Frame-based systems couple a rigid skull-mounted frame to image data, while frameless or image-guided systems rely on surface matching, markers, or fiducials and do not require a fixed skull frame. Intraoperative imaging modalities such as intraoperative MRI, CT, or ultrasound can be integrated to update navigation and compensate for brain shift.

Limitations include registration errors, brain shift after craniotomy, and the need for accurate initial imaging. Access, cost, and training requirements also influence adoption. Ongoing advances include augmented reality overlays, robotic assistance, and tighter integration with intraoperative imaging to improve precision and safety.