Bony surface-matching registration of neuronavigation with sectioned 3-dimensional skull in prone position.

Background Neuronavigation has become an essential system for brain tumor resections. It is sometimes difficult to obtain accurate registration of neuronavigation in prone position. The bony surface-matching registration should be more precise than skin surface-matching registration, however it is difficult to establish bony registration with limited exposed bone. We created a new bony surface-matching method to a section 3-dimensional (D) virtual skull in a neuronavigation system and register with a sectioned 3-D skull. In this study, the bony surface-matching with sectioned 3-D registration is applied to provide precise registration for brain tumor resections in prone position. Methods From May 2023 to April 2024, 17 patients who underwent brain tumor resection in prone position were enrolled. The navigation system StealthStation S8 (Medtronic) was used. Bony surface-matching registration with a whole 3-D skull in a neuronavigation system was performed. Then, a sectioned 3-D skull was made according to surgical location to compare with whole 3-D skull registration. A phantom model was also used to validate between whole and sectioned 3-D skull registration. Results Whole 3-D skull registration was successful in only 2 (11.8%) patients, on the other hand, sectioned 3-D skull registration was successful in 16 (94.1%) patients. The examinations with a phantom skull model also showed superiority of sectioned 3-D skull registration to whole 3-D skull registration. Conclusion Sectioned 3-D skull registration was superior to whole 3-D skull registration. Sectioned 3-D skull method could provide accurate registration with limited exposed bone.