In the pre-CT and MRI era, intra-cranial leisons were diagnosed using clinical localisations and angiography. However, this provided only a rough estimate of the location of the lesion but did not specify the pathology and exact three-dimensional anatomy. This resulted in unexpected findings during surgical procedures and outcomes were guarded. With the rapid advances made in the field of radiology, now, the neurosurgeon is entirely sure about the anatomy and probable pathology of the lesion. Availability of imaging modalities as CT and MRI scans have significantly helped the neurosurgeons to have a three-dimensional overview of the lesion. This has improved the outcomes and reduced the morbidity.
Further advances have occurred in image guidance. Equipments like Stereotaxy and Neuro-Navigation provide image guidance for the surgeon. These help to target deep seated lesions accurately, allow for biopsy, drainage of abscess, under local anaesthesia with minimal surgical morbidity. Dr. Nitin Garg has extensive experience of performing Stereotactic procedures- both frame based and frameless (using navigation)
Neuroavigation is very useful for transcranial, endonasal and spinal procedures. It helps to mark the extent of tumor, localises the eloquent regions so that approach may be modified accordingly. In addition, it also helps to plan the trajectory for various procedures like endoscopic biopsy and ETV. It is very useful in complex spinal fixations like in craniovertebral junction, cervicothoracic junction. Navigation guided MIS TLIFs for spondylolisthesis is the newer method for accurately performing fixations in minimally invasive method using navigation. This modality is being used routinely by Dr.Nitin Garg.
3D-Carm is another advanced intra-operative imaging modality. It provides real-time (during surgery) axial images during the surgery. In patients with complex anatomy like craniovertebral junction, cervical pedicles and dorsal pedicles, it improves the accuracy of instrumentation (screw placement).