Neuronavigation Use Increases Cranial Surgery Duration, Without Significant Discrepancies in Surgery Planning

Introduction Neuronavigation systems have transformed cranial neurosurgery by improving surgeon's ability to assess and operate on brain tumors [1-3]. However, some studies suggest that neuronavigation may affect surgical duration [3- 4]. With increasing use of neuronavigation, it becomes crucial to evaluate its influence on intraoperative intervals to optimise surgical strategy, avoid complications and maximise the advantages of surgical tools [5]. Aim To examine how neuronavigation affects open cranial surgery duration, planning accuracy and intraoperative stages. Methods A retrospective study was conducted using data of 79 patients, who underwent open cranial surgery in 2022, at the Hospital of Lithuanian University of Health Sciences Kaunas clinics, Department of Neurosurgery, Kaunas, Lithuania. Data collected from the operating room management system included use of neuronavigation, surgery length, planned duration, discrepancy of surgery length (DOSL), compared to planned duration. The following intervals were calculated: Entrance into the Operating Room to Initiation of Anesthesia (EOR-IA), Initiation of Anesthesia to Incision (IA-I), Incision to Suturing (I-S), Suturing to the Conclusion of Anesthesia. (S-CA), Conclusion of Anesthesia to Departure from the Operating Room. (CA-DOR). IBM SPSS Statistics was used for statistical analysis, including Mann-Whitney U tests, Tukey's Hinges for interquartile range (IQR), and descriptive statistics. Results Neuronavigation has been associated with significantly longer actual and planned surgery duration. With navigation, median surgery length was 250 min. (IQR = 114 Range: 123 – 436), compared to 172 min. (IQR = 137; Range: 36 – 452; p = 0.0015) without. Median planned duration was 185 min. (IQR = 90; Range: 90 – 385), without navigation, the median was 145 min. (IQR = 120; Range: 35 – 265; p = 0.00068). However, no significant differences were observed in DOSL or any of the operative intervals between the groups with vs. without the use of navigation. Median DOSL was 46 min. (IQR = 70; Range: -69 – 212) when using navigation vs. 48.5 min. (IQR = 73; Range: - 125 – 195; p = 0.94) without. Median intervals (in minutes) with vs without navigation respectively: EOR-IA: 6 vs. 2 (IQR: 8 vs. 2.5; p = 0.36); IA-I: 60 vs. 55 (IQR: 28 vs. 32; p = 0.25); I-S: 150 vs. 126 (IQR: 94.5 vs. 133.5; p = 0.061); S-CA: 27.5 vs. 30 (IQR: 10.5 vs. 10; p = 0.61); CA-DOR: 13 vs. 13.5 (IQR: 15 vs. 18; p = 0.98). Conclusions Neuronavigation use in open cranial surgery was significantly linked to longer surgery and planned duration, but it did not significantly affect the discrepancy between the planned and actual surgery duration. Furthermore, no significant difference was noticed in intraoperative intervals with and without neuronavigation.