The endonasal patient reference tracker: a novel solution for accurate noninvasive electromagnetic neuronavigation

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  • 1 Department of Neurosurgery, Medical University Vienna; and
  • 2 Austrian Center of Medical Innovation and Technology, Wiener Neustadt, Austria
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OBJECTIVE

Electromagnetic (EM) navigation provides the advantages of continuous guidance and tip-tracking of instruments. The current solutions for patient reference trackers are suboptimal, as they are either invasively screwed to the bone or less accurate if attached to the skin. The authors present a novel EM reference method with the tracker rigidly but not invasively positioned inside the nasal cavity.

METHODS

The nasal tracker (NT) consists of the EM coil array of the AxiEM tracker plugged into a nasal tamponade, which is then inserted into the inferior nasal meatus. Initially, a proof-of-concept study was performed on two cadaveric skull bases. The stability of the NT was assessed in simulated surgical situations, for example, prone, supine, and lateral patient positioning and skin traction. A deviation ≤ 2 mm was judged sufficiently accurate for clinical trial. Thus, a feasibility study was performed in the clinical setting. Positional changes of the NT and a standard skin-adhesive tracker (ST) relative to a ground-truth reference tracker were recorded throughout routine surgical procedures. The accuracy of the NT and ST was compared at different stages of surgery.

RESULTS

Ex vivo, the NT proved to be highly stable in all simulated surgical situations (median deviation 0.4 mm, range 0.0–2.0 mm). In 13 routine clinical cases, the NT was significantly more stable than the ST (median deviation at procedure end 1.3 mm, range 0.5–3.0 mm vs 4.0 mm, range 1.2–11.2 mm, p = 0.002). The loss of accuracy of the ST was highest during draping and flap fixation.

CONCLUSIONS

Application of the EM endonasal patient tracker was found to be feasible with high procedural stability ex vivo as well as in the clinical setting. This innovation combines the advantages of high precision and noninvasiveness and may, in the future, enhance EM navigation for neurosurgery.

ABBREVIATIONS DRF = dynamic reference frame; EM = electromagnetic; NT = nasal tracker (endonasal patient reference tracker); RT = reference tracker (for ground truth); ST = skin-adhesive tracker.

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Contributor Notes

Correspondence Stefan Wolfsberger: Medical University Vienna, Austria. stefan.wolfsberger@meduniwien.ac.at.

INCLUDE WHEN CITING Published online July 17, 2020; DOI: 10.3171/2020.4.JNS20394.

Disclosures Dr. Wolfsberger is currently an educational consultant for Medtronic Surgical Technologies and, with Medtronic Navigation, has filed a US patent application.

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