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Modification of Reference Array Attachment for Image Guided Neurosurgery: Direct Cranial Fixation

We have modified the cranial fixation technique of the reference array used for the Stealth (Medtronics Inc., Minneapolis, MN) image guided neurosurgical workstation to avoid rigid immobilization and to accommodate patients undergoing awake procedures. The modification allows attachment of a reference array directly to the skull prior to registration, avoiding the requirement for rigid cranial fixation. The accuracy of fiducial registration for the modified reference array was compared to the conventional reference array using a phantom system yielding similar registration results and target accuracy. The successful application of the modified system to two operative cases is described.