Neuronavigation: how it continues to revolutionise neurosurgical practice

Summary: Neuronavigation is a surgical technology that gives real time image-guidance to neurosurgeons as they operate within the boundaries of the skull and spinal column. Prior to its development, the success of neurosurgery was highly variable as it was determined by the anatomical knowledge, experience and surgical aptitude of each neurosurgeon. However, operations were notoriously difficult, given lesions can be found deep within the brain or spinal cord. To accommodate for this, a large area of exposure was made, which increased the risk of damaging surrounding functional brain tissue. Neuronavigation revolutionised the neurosurgical practice of multiple subspecialites by providing intraoperative image guidance enabling neurosurgeons to precisely locate surgical targets and resect lesions with a minimally invasive technique. Relevance: In neuro-oncology, neuronavigation has increased the proportion of a brain lesion that can resected safely, which has lengthened the duration of survival and reduced post-operative complication rates. In neurovascular surgery, neuronavigation has optimised surgical approaches to difficult to reach cerebral aneurysms and reduced the risk of losing surgical orientation intraoperatively if a haemorrhage is present. In epilepsy surgery, neuronavigation has increased the accurate localisation of epileptogenic zones, which once resected can dramatically reduce the frequency of seizures for epilepsy resistant to medical management. Ultimately, such improvements have transformed patient outcomes worldwide. Take home messages: Neuronavigation has revolutionised the practice of neurosurgery by facilitating minimally invasive surgical technique in a range of neurosurgical subspecialties. It is not a static technology but continues to develop as new technologies continue to be integrated into it, and it presents further exciting prospects for the future of neurosurgery