A Novel Intraoperative Peripheral Nerve Surgery Navigation Technique Using Radar Reflector Localization: Case Series

BACKGROUND AND OBJECTIVES: Intraoperative neuronavigation techniques are limited in peripheral nerve surgery compared with cranial and spinal neurosurgery. This study describes a multicenter, single institutional experience using a radar reflector system as a novel adjunct for intraoperative localization in peripheral nerve surgery. METHODS: This is a retrospective multicenter, single institution case series of the first 21 patients who underwent peripheral nerve surgery with the use of radar reflector-guided localizer between September 2023 and June 2025. All surgeries and pre- and postoperative assessments were performed by 2 senior peripheral nerve neurosurgeons. Patients underwent preoperative ultrasound-guided percutaneous placement of 1 or more implantable radar reflectors by a single musculoskeletal radiologist at a specified anatomic location requested by the surgeon. Intraoperative localization was performed using a handheld radar detector providing real-time audio and distance feedback to reflector location. Data collection including demographics, indications for surgery, use of the nerve navigation system, success of intraoperative reflector localization and retrieval, and adverse outcomes were performed and descriptive results are presented. RESULTS: Twenty-one patients (14 male, 7 female; mean age 57 years) were included in this feasibility analysis. Surgical indications were categorized into 3 groups: nerve tumor resection (n = 7), nerve exploration/neurolysis/repair (n = 10), and nerve transfer (n = 4). Radar reflector was placed 0-164 days before surgery (mean 19 days). Reflectors were successfully identified and removed in all cases, with no device-related complications. CONCLUSION: Radar reflector-guided navigation in peripheral nerve surgery facilitated identification of deep, nonpalpable lesions or anatomically distorted nerves, including in patients with previous surgery, trauma, radiation, or high body mass index. Use of this intraoperative nerve navigation technique is a feasible and safe adjunct for peripheral nerve surgeons. This technique shows promise as a valuable adjunct for enhancing surgical efficiency without compromising safety. Further studies are warranted to validate these findings in a larger cohort and establish best practices for implementation.