gms | German Medical Science

Objective: Navigated endoscopy usually is performed with sharp head fixation. In children younger than 1 year of age and also in older children with thin calvaria due to chronic hydrocephalus sharp head fixation however, is associated with the risk of skull fracture and other complications. Here, we present our experience with the use of electromagnetic (EM) navigation to enhance endoscopic cranial surgery in young children.

Method: Seventeen children (10 boys, 7 girl) aged between 12 days and 16 years (mean age: 4 years, 3 months) underwent electromagnetic navigated endoscopy based on 3D-MR imaging of the cranium. A total of 22 endoscopic procedures were performed. Patients were registered for navigation by surface matching in the supine position and were then repositioned for endoscopic surgery. The head was fixed by a tape to the horseshoe-headholder without rigid head fixation. EM navigation was performed using a flexible stylet inserted into the endoscope. All operations were performed by neurosurgeons experienced in endoscopical and neuronavigated surgery. Neuronavigation accuracy was checked for deviations measured in mm on screen shots after the referencing procedure and during surgery in the coronal (z=vertical), axial (x=lateral) and sagittal (y=anteroposterior) planes.

Results: Navigation accuracy after surface matching ranged between 2 and 4 mm. The EM navigated approach allowed a straight forward approach in guiding the endoscope easily to the lesion with high accuracy in 16/17 patients. It was considered as very useful by the surgeon in each instant.

Conclusions: EM navigated endoscopy in children is a safe and feasible technique enhancing endoscopic surgery without the need for sharp head fixation. It is a valuable alternative to the opto-electric navigation system in this age group.