IMAGE GUIDED NEUROSURGERY: PRESENT STATE AND PERSPECTIVES

The image guided neurosurgery was made possible by the great developments of modern neuroradiology whose origins could be identify in UK on 1974 when Hounsfield invented the computer tomography (CT Scan) and on 1980 Lauterbur developed the first magnetic resonance (MR) allowing the direct visualization of the brain. The term neuronavigation is used to describe the set of computer assisted technologies used by neurosurgeons to guide or “navigate†within the brain. The set of hardware for these purposes is referred to as a “neuronavigatorâ€. Since the beginning the purpose of this technology was to create a mathematical model describing a proposed coordinate system for the space within the skull. This “fiducial spatial coordinate system†is used as a reference to describe the position of specific structures within this arbitrary defined space with high accuracy. Robust computer technologies made possible the real-time quantitative spatial fusion of images of the patient’s brain with the 3D instantaneous position of surgical instruments or probes detected by motion capture technologies guiding the surgeon to selected targets. The experiences and the results obtained by these new approaches at the Istituto Neurologico Besta are illustrated and the expected developments in the near future are discussed.