• A Nimer Amr, Jens Conrad, Sven Kantelhardt, and Alf Giese.
• Department of Neurosurgery, University of Mainz, Mainz, Germany. Electronic address: amr@uni-mainz.de.
• World Neurosurg. 2017 Sep 1; 105: 386-393.

BackgroundA drawback of conventional neuronavigation is the necessity of focusing on two-dimensional images in 3 planes at the same time to determine one's position in the operating field. A solution would be to merge the images into a single three-dimensional (3D) image that mirrors the actual anatomy. The introduction of holographic glassless 3D monitors paved the way to 3D navigation. We present our experience with 3D neuronavigation as exemplified by navigation to and within the sella.MethodsOperative planning was conducted with a navigation system using cranial computed tomography and magnetic resonance imaging. The image data sets were processed by the prototype Clariti 3D system to produce a 3D rendering of images. The 2 systems were then synced, enabling real-time 3D navigation. Operations were performed via an endoscopic transsphenoidal approach.Results3D navigation was intuitive, simple, and safe to use. Rendered images reflected both the anatomic configuration and the spatial depth of the operating field. The 3D monitor showed no deviation from the calculated navigation. We were able to segment anatomic structures at risk to easily identify them. Surgeons reported a short learning curve and rapidly adapted to the system. 3D navigation was a good supplement to conventional two-dimensional triplane navigation.Conclusions3D navigation is a beneficial supplement that extends capabilities of conventional navigation, especially with regard to orientation in objects with complex spatial depth and configuration. The additional planning and export/sync procedures are the main disadvantages; merging the navigation system with the 3D monitor in a single system could alleviate this problem.Copyright © 2017 Elsevier Inc. All rights reserved.

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