Impact of Image Guidance on Complication Rates and Operation Time in Lateral Suboccipital Approaches

Objective: Image-guidance systems are widely available for surgical planning and intraoperative navigation. Recently, 3D volumetric image-rendering technology has increasingly been applied in navigation systems to assist neurosurgical planning, e.g., for skull base approaches. However, there is no systematic clinical study available so far focusing on the impact of this image-guidance technology on outcome parameters in suboccipital craniotomies.

Methods: A total of 200 patients with pathologies located in the cerebellopontine angle were reviewed, 100 of which were performed with volumetric neuronavigation and 100 of which were performed without intraoperative image guidance. This retrospective study analyzed the impact of image guidance on complications rates (venous sinus injury, venous air embolism (VAE), postoperative morbidity caused by VAE) and operation time for the lateral suboccipital craniotomy in the semisitting position.

Result: This study demonstrated a 4% incidence of injury to the transverse-sigmoid sinus complex in the image-guided group compared with a 15% incidence in the non-image-guided group. VAE was detected in 8% of the image-guided cases and in 19% of the non-image-guided cases. These differences in terms of complication rates were significant for both venous sinus injury and VAE (p ≤ 0.05). There was no difference in postoperative morbidity secondary to VAE between the groups. The mean time for craniotomy was 21 minutes in the image-guided group and 39 minutes in the non-image-guided group (p = 0.036).

Conclusion: Volumetric image guidance provides fast and reliable 3D visualization of sinus anatomy in the posterior fossa, and thereby increases significantly speed and safety in lateral suboccipital approaches.