The role of frameless neuronavigation in the surgical treatment of patients with occlusive lesions of extra-intracranial blood vessels in the brain

AIM . To compare the surgical treatment outcomes of patients with occlusive lesions of the extra-intracranial arteries of the brain, operated on with and without frameless neuronavigation. MATERIALS AND METHODS . The study was conducted at the bases of the Pirogov Russian National Research Medical University and the Russian Center for Neurology and Neuroscience from 2016 to 2023. The analysis included 59 patients with occlusive lesions of the extra-intracranial arteries of the brain, divided into three groups. Group 1 included 19 patients (32.2 %) (16 men and 3 women, median age 59 years) who underwent extra-intracranial arterial bypass grafting (EIABG) without the use of frameless neuronavigation. Group 2 included 19 patients (32.2 %) (12 men and 7 women, median age 58 years) who underwent EIABG with the use of frameless neuronavigation only during the access planning stage based on CT angiography (stage 1) – for marking the donor artery, skin incision, and craniotomy. Group 3 included 21 patients (35.5 %) (14 men and 7 women, median age 58 years) who underwent EIABG with the use of frameless neuronavigation at both the access planning stage and the main stage of the operation – for marking the donor artery, locating the recipient artery using CT angiography and SPECT considering the hypoperfusion area, craniotomy, and skin incision. RESULTS . The use of frameless neuronavigation significantly reduces the size of the skin incision (p1–3=0.01, p2–3=0.016), the area of craniotomy (p1–3=0.04), and the size of resection trepanation (p1–3=0.049). Frameless navigation increases the perfusion gain in the hypoperfusion area (p1–3=0.007) and allows for targeted revascularization of the hypoperfusion region (p1–3=0.003, p2–3=0.003). Frameless navigation did not significantly affect: blood loss volume (p=0.849), anastomosis functionality (p=0.161), linear blood flow velocity (p=0.066), RMC index (p=0.859), functional outcomes after surgery (p=0.42), development of new neurological deficits (p=1.0), systemic complications (p=0.833), or the number of days spent in intensive care (p=0.144) and the hospital (p=0.156). CONCLUSION . In patients with occlusive lesions of the extra-intracranial arteries of the brain, the use of frameless neuronavigation enhances the effectiveness of the main stage of the operation, allows for targeted revascularization of the hypoperfusion region, and reduces the length of the skin incision as well as the size of the cranioplasty and resection trepanation.