What is neuronavigation?

Using technology similar to a global positioning system (GPS), neuronavigation gives Dr Steel the ability to see a patient’s anatomy in three dimensions and pinpoint a location in the brain or spinal cord with the aid of diagnostic images such as computer tomography (CT) and magnetic resonance (MR).

These images can be used with intra-operative images such as x-rays or CT scans to track the surgical procedure and instrumentation in real time, in relation to a patients’ anatomy. When performing surgery through small incisions, this allows feedback to Dr Steel so he can know precisely where critical structures are in relation to the surgical instruments.

The term neuronavigation is synonymous with image guided surgery (IGS), computer assisted surgery (CAS) and stereotactic navigation.

How does neuronavigation technology work?

You can compare surgical navigation technology to the location and directional tracking system used in cars today. It is, in effect, a GPS system for the surgeon.

As drivers use a GPS to navigate roads, Dr Steel uses these images to confirm the position of his instruments in a patient’s body. As Dr Steel moves an instrument in the body, the position is precisely calculated. The data is transferred using infrared cameras to a computer in the operating room.

The computer then superimposes the position of the instruments as they are used in surgery onto images of the anatomy displayed on a monitor. This allows Dr Steel to see the real time positioning of his instruments in three dimensions.

Why is it beneficial for surgeons to use neuronavigation during surgery?

Using neuronavigation helps Dr Steel accurately detect where he is working in a patient’s body at every moment during surgery.

This allows him to make smaller incisions and minimise the exposure. In turn, this minimises trauma to the body, as less healthy tissue needs to be disturbed to get to the site of the pathology.

With accuracy of one to two millimetres, instruments can be placed into a patient’s body with precision, minimising potential complications.

It allows the surgical exposure to be planned prior to the operation. Also, instrumentation and retraction can be formulated during surgery with increased confidence in the surrounding anatomical structures.

In what ways can neuronavigation affect my recovery?

Trauma, pain and scarring can be minimised due to the smaller incisions and Dr Steel’s increased ability to avoid damaging healthy tissue. The technology may also mean better long-term results and decrease the chance of repeat surgery.

What steps are involved in neuronavigation?

There are four broad steps in a neuronavigation procedure:

1. Before surgery, a diagnostic image (usually a CT or MR scan) is performed. This is then loaded into a computer.
2. The scan is used to create a 3D model of the patient’s anatomy.
3. At the beginning of the surgery, Dr Steel maps the patient’s anatomy using special techniques and an infrared camera in the operating room. The computer system then links the pre-operative diagnostic image to the patient’s anatomy.
4. Using the neuronavigation system as a tool, Dr Steel can then see his instruments on the computer image and confirm their exact location at any time.

How do patients benefit from neuronavigation in brain surgery?

When performing surgery in the brain, the navigation system allows Dr Steel to tailor his approach to the structure in the brain, causing minimal disruption or retraction to surrounding tissue.

The system allows Dr Steel to ‘see’ through the scalp, skull and brain so trajectories can be planned.

It allows Dr Steel to see whether he has successfully removed the entire tumour and avoid damage to surrounding healthy tissue during deep brain stimulation (DBS).

It allows Dr Steel to confidently and precisely choose the exact point to place stimulators and other instruments to treat Parkinson’s disease and other neurological disorders.

How do patients benefit from neuronavigation in spine surgery?

Absolute precision is necessary in spine surgery because of its proximity to the spinal cord and nerves. Spinal navigation helps Dr Steel navigate through the bone, while avoiding damage to the adjacent neural structures.

This not only helps Dr Steel perform a minimally invasive procedure, but it allows him to visualise and plan the exact incision and screw placement.

Dr Steel can pass instruments into the vertebrae with more confidence and a higher degree of accuracy.

How widely used is neuronavigation?

Neuronavigation is being increasingly used by neurosurgeons and spine surgeons around the world to make surgery safer and more effective. Dr Steel has been at the forefront of developing navigation in neurosurgery.

He was involved in the initial trial of the first ‘frameless’ stereotactic navigation systems when they were being used for brain tumour surgery in 1996.

Dr Steel was also one of the first neurosurgeons in Australia to use navigation for spine surgery, pioneering its use for spinal fusion and minimally invasive spine fixation for thoracolumbar burst fractures.

In 2009 he presented research on the accuracy of stereotactic navigation and the placement of instrumentation in spine surgery at the sixth Asia Pacific Spine Symposium in Kōbe, Japan.