Frameless neuronavigation in surgery of distal cerebral aneurysms

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Abstract
Aim. To compare results of surgical treatment of patients with distal aneurysms of the middle cerebral and pericallosal arteries who underwent surgery with frameless neuronavigation and without it. Materials and methods. The study was performed at the N. V. Sklifosovsky Research Institute for Emergency Medicine, Russian Сenter of Neurology and Neurosciences, Moscow City Hospital named after S. S. Yudin between January 1st 2009 and December 31st 2023. Analysis included 45 patients with distal aneurysms of the pericallosal and middle cerebral arteries. Taking into account surgical technique, the patients were divided into 2 groups: the 1st group (n = 21) included patients who underwent surgery with frameless neuronavigation; among them 10 (47.6 %) patients had distal aneurysms of the middle cerebral artery, 11 (52.4 %) patients had distal aneurysms of the pericallosal artery. The 2nd group (n = 24) included patients who underwent surgery without frameless neuronavigation; among them 10 (41.7 %) patients had distal aneurysms of the middle cerebral artery, 14 (58.3 %) patients had distal aneurysms of the pericallosal artery. Results. The use of frameless neuronavigation helps in the search for distal aneurysms during the main stage of the surgery, decreases time between dissection and clipping of a distal aneurysm (p = 0.0001), decreases operative time (р = 0.0001) but requires more time for access planning (p = 0.008). Frameless neuronavigation helps to determine optimal size and location of craniotomy for the most direct and safe trajectory to the distal aneurysm (p = 0.008), decreases the risk of intraoperative injury of the frontal sinus (p = 0.025). Patients, in whom distal aneurysm clipping was performed using frameless navigation, had lower rate of neurologic deficit (p = 0.0001), postoperative (p = 0.025) and systemic (p = 0.005) complications, repeat surgeries (p = 0.002). Conclusion. The use of frameless neuronavigation decreases search time for distal aneurysms and operative time, allows to decrease craniotomy area and prevent intraoperative injury of the frontal sinus, statistically significantly decreases the risk of postoperative neurologic deficit, and improves clinical outcomes.

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