Image-Guided Brain Surgery
Image-guided brain surgery, also known as surgical neuronavigation, is an advanced technology that functions like a high-precision GPS for the neurosurgeon. By loading 3D MRI or CT scans into a computer system in the operating theatre, the technology tracks the surgeon’s micro-instruments in real time in relation to the patient’s brain anatomy. This allows the surgeon to plan the smallest possible skull window, navigate around critical brain pathways with sub-millimetre accuracy, and safely remove deep-seated lesions.
When this procedure may be recommended
- All standard brain tumour resections (gliomas, meningiomas, metastases).
- Biopsies of deep-seated or small intracranial lesions.
- Localisation of vascular malformations (AVMs, cavernomas).
- Placement of ventriculoperitoneal shunts or stereotactic EEG electrodes.
Who may be a candidate
Employed in almost all modern cranial procedures to maximize safety and precision. It is highly beneficial for deep or small lesions where direct visualization is difficult.
Advanced medical implant technology (no text). Alternatives to surgery
- Traditional landmark-based cranial surgery (less precise, requiring larger incisions and skull openings).
What to expect
- Pre-operative Scan: The patient undergoes a high-resolution "navigation protocol" MRI or CT scan with specialized marker stickers on the scalp.
- Data Upload: The 3D imaging data is uploaded into the neuronavigation computer system in the theatre.
- Registration: In the theatre, the surgeon touches specific anatomical points on the patient’s head with an optical probe, synchronizing the real-world head with the 3D computer model.
- Real-time Navigation: Throughout the surgery, optical cameras track the surgical instruments and display their exact position on the 3D scan, guiding the surgeon directly to the target lesion.
Technology and imaging
Employs infrared tracking cameras, electromagnetic navigation fields, specialized 3D registration software, and integration with high-end digital microscopes.
High-precision diagnostic imaging visualization. 
Clinical Zeiss/Leica operating microscope setup. Hospital stay
Determined by the primary procedure performed (e.g., standard craniotomy or biopsy). The technology itself does not add to hospital stay.
Recovery milestones
- Follows the recovery pathway of the primary cranial procedure being navigated.
Post-operative mobilization and recovery milestones. Risks and complications
- "Brain shift" error: as spinal fluid drains or a tumour is removed, the brain can shift slightly, reducing the navigation system’s initial accuracy (managed by intraoperative ultrasound or updating landmarks).
- Technical tracking malfunction.
Frequently asked questions
Does the navigation system move my instruments?
No. The navigation system does not move your hands or make incisions. It acts purely as a map and GPS guidance screen, allowing the surgeon to see exactly where their instruments are located within the 3D anatomy of the brain.
What is brain shift?
Brain shift refers to the small movement of brain tissue that occurs during surgery due to fluid drainage or tumour removal. Dr Aliashkevich compensates for this by using real-time intraoperative ultrasound to update the navigation scans during the procedure.