Registration-free Workflow for Stereotactic Neurosurgery Guided by a Novel Electromagnetic Navigation System

Abstract

Electromagnetic navigation systems (ENS) provide a promising solution for tracking electrode positioning during deep brain stimulation (DBS) surgery, enhancing precision and potentially improving clinical outcomes. Recent studies suggest that novel ENS based on quasi-static magnetic fields may be compatible with the DBS surgical environment, particularly with stereotactic systems - the gold standard for electrode implantation. However, a key challenge persists: ensuring seamless integration into the surgical workflow requires an efficient and reliable patient-to-image registration system. In this study, we present a novel registration system tailored for stereotactic procedures. The system employs flexible markers attached to the stereotactic frame, incorporating magnetic sensors and wireless communication to enable seamless interaction with the surgical environment. These markers are visible on preoperative computed tomography (CT) scans, eliminating the need for additional intraoperative imaging. The registration method demonstrated robust performance with automatic segmentation of the markers on CT images, achieving an average point matching error of 1.51 mm. During implantation tests, the system localized the ENS sensors with a target registration error of 2.54 ± 0.92 mm. This innovative navigation approach ensures precise localization, reducing reliance on repeated CT imaging for verification, thus streamlining the surgical workflow. Clinical Relevance- This proposes a registration-free approach for stereotactic neurosurgery, enabling the monitoring of electrode position and orientation during implantation.