gms | German Medical Science

In many reports on neuronavigation it is implied that it improves the safety of neurosurgical procedures, without presenting hard evidence. Our goal was to determine the influence of modern image-guided techniques on complications in neurosurgical procedures in comparison to standard microsurgery.

All procedures performed with neuronavigation within a period of 5 years as well as all other operations in that period were assessed regarding surgical or neurological complications. The latter were divided into unexpected new neurological deficits and neurological deficits that could be expected from the tumour type and/or location, no matter whether transient or permanent. Navigated and standard operations then were compared regarding complication-rates.

506 of a total of 6615 operations were performed with neuronavigation and a total of 861 operations comparable to navigated procedures were performed without navigation. Impaired wound healing occurred in 1.1% of all operations and 1.6 % of navigations and postoperative bleeding in 1.6% vs. 1.9%. Unexpected central neurological deficits occurred in 4.5% of the standard and only 3.7% of the navigated operations. The rate of expected deficits on the other hand was higher (12.1%) in neuronavigation operations than in standard procedures (9.6%), indicating a selection towards more complicated lesions in neuronavigation cases.

General surgical complications are not significantly different in procedures with or without neuronavigation. The critical interpretation of the results for neurological complications does not support the general view of improved safety with neuronavigation. However the data is not conclusive and since randomized studies are hardly justifiable, historical matched pair analyses should be performed.