Endoscopic third ventriculostomy assisted by augmented reality.

Augmented reality (AR) technology has witnessed remarkable advancements in recent years, revolutionizing various fields, including medicine and surgery. In neurosurgery, AR holds immense promise for improving the accuracy, efficiency, and safety of various procedures. Augmented reality allows a user to visualize digital information such as 3D models, superimposed on their real-world field of view. Lately, there has been increased use of this technology for various procedures such as tumor resection, ventriculostomy, and pedicle screw insertion. Despite this, integration of AR into the field of neurosurgery is still in its infancy. As such, it is imperative that physicians continue to explore and document new clinical uses of AR. In this report, we describe the novel integration of AR into an endoscopic third ventriculostomy (ETV) case. ETV is a minimally invasive technique used to treat hydrocephalus, which involves creating a new pathway for cerebrospinal fluid (CSF) drainage within the brain's ventricular system. The integration of AR into ETV procedures offers unprecedented opportunities to enhance surgical visualization, navigation, and decision-making, ultimately leading to improved patient outcomes. Traditionally, neurosurgeons rely on pre-operative imaging, intraoperative neuronavigation systems, and their anatomical knowledge to perform an ETV. However, the complex neuroanatomy and variability among patients pose challenges to accurate navigation and spatial orientation prior to and during surgery. AR technology addresses these challenges by overlaying digital information-such as three-dimensional models, anatomical landmarks, and surgical trajectories-onto the surgeon's view of the patient in real-time.

Optimizing surgical technique in microvascular decompression for hemifacial spasm - Results from a surgical series with contemporary use of neuronavigation and intraoperative neuromonitoring.

Background: Microvascular decompression (MVD) through a retrosigmoid approach is considered the treatment of choice in cases of hemifacial spasm (HFS) due to neurovascular conflict (NVC). Despite the widespread of neuronavigation and intraoperative neuromonitoring (IONM) techniques in neurosurgery, their contemporary application in MVD for HFS has been only anecdotally reported. Methods: Here, we report the results of MVD performed with a combination of neuronavigation and IONM, including lateral spread response (LSR) in 20 HFS patients. HFS clinical outcome and different surgical-related factors, such as craniotomy size, surgical duration, mastoid air cell (MAC) opening, postoperative cerebral spinal fluid (CSF) leakage, sinus injury, and other complications occurrence, and the length of hospitalization (LOS) were studied. Results: Postoperatively, residual spasm persisted only in two patients, but at the latest follow-up (FU) (mean: 12.5 ± 8.98 months), all patients had resolution of symptoms. The mean surgical duration was 103.35 ± 19.36 min, and the mean LOS was 2.21 ± 1.12 days. Craniotomy resulted in 4.21 ± 1.21 cm2 in size. Opening of MAC happened in two cases, whereas no cases of CSF leak were reported as well as no other complications postoperatively and during FU. Conclusion: MVD for HFS is an elective procedure, and for this reason, surgery should integrate all technologies to ensure safety and efficacy. The disappearance of LSR is a crucial factor for identifying the vessel responsible for NVC and for achieving long-term resolution of HFS symptoms. Simultaneously, the benefits of using neuronavigation, including the ability to customize the craniotomy, contribute to reduce the possibility of complications.

Neuro Navigation Versus Conventional Spinal Techniques in Analyzing Nerve Injury and Anatomical Accuracy: A Systematic Review.

Neuronavigation, a computer-assisted surgical technique, enhances the accuracy of spinal surgery by using medical imaging to guide the surgeon's instruments. This method mitigates the serious complications of screw misplacement, such as dural tears, nerve damage, vascular injuries, and internal organ damage, by integrating pre-operative imaging data with real-time intraoperative sensor readings. Because of this integration, it is possible to visualize the spine in three dimensions, guaranteeing accurate instrument placement and greatly lowering the risk of complications. Despite its growing popularity, the benefits of neuronavigation in spinal instrumentation are debated. While some studies report improved accuracy in pedicle screw placement, others find no significant difference compared to conventional freehand techniques. Further research is required to determine the long-term benefits of neuronavigation, including its impact on patient outcomes, like reduced pain and improved function. This systematic review will evaluate the evidence on the risks and benefits of neuronavigation in spinal instrumentation surgery, compared to conventional techniques.

Efficacy study of neuronavigation-assisted stereotactic drilling of urokinase drainage versus craniotomy in the treatment of massive intracerebral haemorrhage in elderly patientsa.

To evaluate the efficacy of neuronavigation-assisted stereotactic drilling drainage compared with that of craniotomy in the treatment of massive intracerebral haemorrhage (ICH) in elderly patients. This was a randomized, controlled, blind endpoint clinical study. Elderly patients with massive ICH treated at our neurosurgery department, without the formation of brain herniation preoperatively, all underwent neurosurgical intervention. Patients were randomly assigned to two groups: the minimally invasive surgery (MIS) group, which received neuronavigation-assisted stereotactic drilling drainage, and the craniotomy haematoma removal surgery (CHRS) group. Patient characteristics, surgical anaesthesia methods, surgery duration, intraoperative bleeding volume, duration of ICU stay duration of hospital stay, complications, and modified Rankin scale (mRS) scores at 90 days posttreatment were compared between the two groups. Statistical analysis was performed on the collected data. A total of 67 patients were randomly assigned, with 33 (49.25%) in the MIS group and 34 (50.75%) in the CHRS group. Compared with the CHRS group, the MIS group had advantages, including the use of local anaesthesia, shorter surgery duration, less intraoperative bleeding, shorter ICU stay, and fewer complications (P < 0.05). The MIS group had a significantly improved patient prognosis at 90 days (mRS 0-3). However, there were no significant differences in hospital stay or 90-day survival rate between the two groups (P > 0.05). For elderly patients with massive ICH without brain herniation, stereotactic drilling drainage is a simple surgical procedure that can be performed under local anaesthesia. Patients treated with this approach seem to have better outcomes than those treated with craniotomy. In clinical practice, neuronavigation-assisted stereotactic drilling drainage is recommended for surgical treatment in elderly patients with massive ICH without brain herniation.Clinical trial registration number: NCT04686877.

The use of intraoperative CT-neuronavigation in Wiltse approach. A technical note.

Introduction: The paraspinal approach was first introduced in 1968 and later refined by Leon Wiltse to gain access to the lateral interevertebral foraminal region. However, challenges can arise due to unfamiliarity with this approach, unique patient anatomy, or in case of revision surgery, potentially elevating the risk of complications and/or poor outcome. Methods: Here we report on two cases in which the intraoperative Oarm CT neuronavigation was used during a Wiltse approach. Under general anesthesia, the spinous process near the surgical level is exposed through a midline incision. The patient's reference anchor is then attached to the exposed spinous process. Intraoperative CT is acquired and transferred to the Stealth Station S8 Surgical Navigation System (Medtronic). The Wiltse approach is now performed through a paramedian incision under neuronavigation guidance and perfectly tailored to the patient's unique anatomy. Results: The first case was a patient harboring a left lumbar intraextraforaminal schwannoma and the second one was a patient with an extraforaminal lumbar disc herniation at the adjacent level of a previous lumbar instrumentation. We were able to easily identify and remove both the lesions minimizing the surgical approach with no complication and optimal clinical outcome. Discussion and Conclusion: Our cases demonstrate the feasibility of application of intraoperative O-arm CT-neuronavigation to the Wiltse approach. In our opinion, this technique helps in minimizing the surgical approach and rapidly identifying the lesion of interest. Further studies are needed to address the effective utility and advantages of intraoperative CT-neuronavigation in this specific surgical scenario.

Neuronavigation combined with intraoperative ultrasound and intraoperative magnetic resonance imaging vs neuronavigation alone in diffuse glioma surgery.

OBJECTIVE: This study aimed to integrate intraoperative ultrasound (IUS) and magnetic resonance imaging (IMRI) with neuronavigation (NN) to create a multimodal surgical protocol for diffuse gliomas. Clinical outcomes were compared to the standard NN-guided protocol. METHODS: Adult patients with diffuse gliomas scheduled for gross total resection (GTR) were consecutively enrolled to undergo either NN-guided surgery (80 patients, July 2019-January 2022) or multimodal-integrated surgery (80 patients, February 2022-August 2023). The primary outcomes were the extent of resection (EOR) and GTR. Additional outcomes included operative time, blood loss, length of hospital stay, and patient survival. RESULTS: GTR was achieved in 69% of patients who underwent multimodal-integrated surgery, compared to 43% of those who received NN-guided surgery (P=0.002). Residual tumor was detected by IMRI in 53 patients (66%), and further GTR was achieved in 28 of these cases. The median EOR was 100% for the multimodal group and 95% for the NN-guided group (P=0.001), while the median operative time was 8 hours versus 5 hours (P<0.001). Neurological deficits, blood loss, and hospital stay durations were comparable between two groups. Multimodal-integrated surgery resulted in greater EOR and higher GTR rates in contrast-enhancing gliomas, gliomas in eloquent regions, and large gliomas (≥50mm). GTR in glioblastomas and other contrast-enhancing gliomas contributed to improved overall survival. CONCLUSIONS: Compared to standard NN-guided surgery, multimodal-integrated surgery using NN, IMRI, and IUS significantly increased the EOR and GTR rates for diffuse gliomas.

Operative Adjuncts in Pediatric Brain Tumor Surgery with a Focus on Suprasellar Tumors.

The primary objective of surgery for brain tumor resection has always been maximizing safe resection while minimizing the risk to normal brain tissue. Technological advances applied in the operating room help surgeons to achieve this objective. This chapter discusses specific tools and approaches in the operating environment that target safe surgery for brain tumors in children, with a focus on pathologies in the sellar/suprasellar region. Particular focus is given to tools that help with safe patient positioning; intraoperative imaging modalities; and chemical visualization adjuncts. Both static (preoperative images used for neuronavigation) and dynamic (images updated during the procedure) intraoperative imaging modalities are discussed. There is further overview of operative rehearsal and preparation strategies, which are rapidly evolving as virtual reality systems become more commonplace. While the rapid evolution of intraoperative adjuncts in neurosurgery means the status of a given technology as novel is quite transient, this chapter offers a snapshot of the current state of advanced intraoperative tools for pediatric brain tumor surgery.

Top 100 Most Cited Articles on Intraoperative Image-Guided Navigation in Spine Surgery.

Navigation technologies have become essential in spine surgery over the last decade, offering precise procedures and minimizing risks. To the best of our knowledge, this is the first bibliometric analysis on this topic, providing insights and trends on topics, authors, and journals. The study identifies and analyzes the 100 most cited articles related to navigation in spine surgery. A systematic search was performed in Scopus and Google Scholar to identify all articles related to navigation in spine surgery (38,057 articles). The 100 most cited were analyzed for citations, titles, abstracts, authors, affiliations, keywords, country and institute of origin, year of publication, and level of evidence. The search was conducted in October 2023. The 100 most cited articles were published between 1995 and 2019, with 2010 to 2019 being the most prolific decade (46%). The most cited article had 733 citations, and the paper with the most citations per year averaged 59.27 citations/year. The Spine Journal had the most articles (34%). The United States contributed the most articles (39%). Most publications were clinical research and reviews (94%), with an overall evidence grade of IV-V (63%). A positive trend was noted in the last decade for incorporating augmented reality. This bibliometric analysis offers valuable insights and trends in spine surgery navigation literature. The findings indicate that technological advancements have led to more articles with higher levels of evidence. These pivotal articles shape evidence-based medicine, future surgeons, and industry improvements in navigated spine surgery.

Neuronavigation in glioma resection: current applications, challenges, and clinical outcomes.

Background: Glioma resection aims for maximal tumor removal while preserving neurological function. Neuronavigation systems (NS), with intraoperative imaging, have revolutionized this process through precise tumor localization and detailed anatomical navigation. Objective: To assess the efficacy and breadth of neuronavigation and intraoperative imaging in glioma resections, identify operational challenges, and provide educational insights to medical students and non-neurosurgeons regarding their practical applications. Methods: This systematic review analyzed studies from 2012 to 2023 on glioma patients undergoing surgical resection with neuronavigation, sourced from MEDLINE (PubMed), Embase, and Web of Science. A database-specific search strategy was employed, with independent reviewers screening for eligibility using Rayyan and extracting data using the Joanna Briggs Institute (JBI) tool. Results: The integration of neuronavigation systems with intraoperative imaging modalities such as iMRI, iUS, and 5-ALA significantly enhances gross total resection (GTR) rates and extent of resection (EOR). While advanced technology improves surgical outcomes, it does not universally reduce operative times, and its impact on long-term survival varies. Combinations like NS + iMRI and NS + 5-ALA + iMRI achieve higher GTR rates compared to NS alone, indicating that advanced imaging adjuncts enhance tumor resection accuracy and success. The results underscore the multifaceted nature of successful surgical outcomes. Conclusions: Integrating intraoperative imaging with neuronavigation improves glioma resection. Ongoing research is vital to refine technology, enhance accuracy, reduce costs, and improve training, considering various factors impacting patient survival.

Unlocking Precision in Spinal Surgery: Evaluating the Impact of Neuronavigation Systems.

OBJECTIVE: In spine surgery, ensuring the safety of vital structures is crucial, and various instruments contribute to the surgeon's confidence. This study aims to present outcomes from spinal cases operated on using the freehand technique and neuronavigation with an O-arm in our clinic. Additionally, we investigate the impact of surgical experience on outcomes by comparing early and late cases operated on with neuronavigation. METHOD: We conducted a retrospective analysis of spinal patients operated on with the freehand technique and neuronavigation in our clinic between 2019 and 2020, with a minimum follow-up of 2 years. Cases operated on with neuronavigation using the O-arm were categorized into early and late groups. RESULTS: This study included 193 patients, with 110 undergoing the freehand technique and 83 operated on utilizing O-arm navigation. The first 40 cases with neuronavigation formed the early group, and the subsequent 43 cases comprised the late group. The mean clinical follow-up was 29.7 months. In the O-arm/navigation group, 796 (99%) of 805 pedicle screws were in an acceptable position, while the freehand group had 999 (89.5%) of 1117 pedicle screws without damage. This rate was 98% in the early neuronavigation group and 99.5% in the late neuronavigation group. CONCLUSIONS: The use of O-arm/navigation facilitates overcoming anatomical difficulties, leading to significant reductions in screw malposition and complication rates. Furthermore, increased experience correlates with decreased surgical failure rates.

Applications of Augmented Reality in Neuro-Oncology: A Case Series.

Augmented reality (AR) is a technological tool that superimposes two-dimensional virtual images onto three-dimensional real-world scenarios through the integration of neuronavigation and a surgical microscope. The aim of this study was to demonstrate our initial experience with AR and to assess its application in oncological neurosurgery. This is a case series with 31 patients who underwent surgery at Santa Casa BH for the treatment of intracranial tumors in the period from March 4, 2022, to July 14, 2023. The application of AR was evaluated in each case through three parameters: whether the virtual images auxiliated in the incision and craniotomy and whether the virtual images aided in intraoperative microsurgery decisions. Of the 31 patients, 5 patients developed new neurological deficits postoperatively. One patient died, with a mortality rate of 3.0%. Complete tumor resection was achieved in 22 patients, and partial resection was achieved in 6 patients. In all patients, AR was used to guide the incision and craniotomy in each case, leading to improved and precise surgical approaches. As intraoperative microsurgery guidance, it proved to be useful in 29 cases. The application of AR seems to enhance surgical safety for both the patient and the surgeon. It allows a more refined immediate operative planning, from head positioning to skin incision and craniotomy. Additionally, it helps decision-making in the intraoperative microsurgery phase with a potentially positive impact on surgical outcomes.

How do I do it? Real-time three-dimensional robotic C-arm navigation for ventriculoperitoneal shunting.

BACKGROUND: Ventriculoperitoneal (VP) shunts are commonly used for managing hydrocephalus, with mechanical dysfunction being the most common cause of complications that require revision. A VP shunt placed using a real-time three-dimensional (3D) robotic C-arm navigation system may have better outcomes and fewer complications. METHODS: In this technical note, we introduced the workflow of the use of the real-time 3D robotic C-arm navigation system for ventriculoperitoneal shunting. CONCLUSION: The real-time 3D robotic C-arm can provide a more precise approach to the target. Furthermore, this technique may lower the risk of complications and increase the success rate of shunt placements.

Stealth Autoguide as Robotic Holder for Cranial Endoscopic Surgery: Technical Note and Proof of Concept.

BACKGROUND: The Stealth Autoguide (Medtronic, Minneapolis, MN) is a robotic auto-targeting device for stereotactic brain biopsy, placement of stereoelectroencephalography electrodes, and laser ablation therapy. This paper evaluates its off-label application as robotic endoscope holder in transnasal and intraventricular neurosurgery. The potential to enhance stability, reduce manual adjustments, and improve surgical precision is discussed, alongside cost-effectiveness and feasibility. METHODS: Patients who underwent endoscopic endonasal, transventricular, and microsurgical endoscopic-assisted surgeries using the Stealth Autoguide as robotic holder from August 2023 to March 2024 were included. Surgical data and surgeons' remarks on advantages, disadvantages and limitations of the technique were collected. RESULTS: In this preliminary experience, Stealth Autoguide has proven safe and effective for several approaches. It was successfully used for patients with sellar, parasellar, and suprasellar lesions. Moreover, the holder was used in a third ventriculocisternostomy, a septostomy, and a removal of intraventricular lesion. Finally, the Autoguide has been a useful holder for the endoscope after gross total microsurgical excision of a tumor: The robot aligned the endoscope to the chosen trajectory and allowed the surgeon to "look around the corner" and confirm the extent of resection. No complications occurred in the treated cases, and the system provided great stability and usefulness throughout the surgeries. CONCLUSIONS: This experience proves that the Stealth Autoguide can be safely and effectively used as a robotic support for endoscopic procedures. This device ensures precise positioning and manipulation of neuroendoscopes, facilitating visualization and targeting of the desired area. Further researches are needed to verify applications and limitations.

Clinical implementation, barriers, and unmet needs of rTMS and neuro-navigation systems in stroke rehabilitation: a nationwide survey in South Korea.

Objective: The objective of this study was to determine the implementation, clinical barriers, and unmet needs of repetitive transcranial magnetic stimulation (rTMS) and neuro-navigation systems for stroke rehabilitation. Design: We employed a nationwide survey via Google Forms (web and mobile) consisting of 36 questions across rTMS and neuro-navigation systems, focusing on their implementation, perceptions, and unmet needs in stroke recovery. The survey targeted physiatrists registered in the Korean Society for Neuro-rehabilitation and in rehabilitation hospitals in South Korea. Results: Of 1,129 surveys distributed, 122 responses were analyzed. Most respondents acknowledged the effectiveness of rTMS in treating post-stroke impairments; however, they highlighted significant unmet needs in standardized treatment protocols, guidelines, education, device usability, and insurance coverage. Unmet needs for neuro-navigation were also identified; only 7.4% of respondents currently used such systems, despite acknowledging their potential to enhance treatment accuracy. Seventy percent of respondents identified lack of prescription coverage, time and errors in preparation, and device cost as barriers to clinical adoption of neuro-navigation systems. Conclusion: Despite recognition of the potential of rTMS in stroke rehabilitation, there is a considerable gap between research evidence and clinical practice. Addressing these challenges, establishing standardized protocols, and advancing accessible neuro-navigation systems could significantly enhance the clinical application of rTMS, offering a more personalized, effective treatment modality for stroke recovery.

Model-based navigation of transcranial focused ultrasound neuromodulation in humans: Application to targeting the amygdala and thalamus.

BACKGROUND: Transcranial focused ultrasound (tFUS) neuromodulation has shown promise in animals but is challenging to translate to humans because of the thicker skull that heavily scatters ultrasound waves. OBJECTIVE: We develop and disseminate a model-based navigation (MBN) tool for acoustic dose delivery in the presence of skull aberrations that is easy to use by non-specialists. METHODS: We pre-compute acoustic beams for thousands of virtual transducer locations on the scalp of the subject under study. We use the hybrid angular spectrum solver mSOUND, which runs in ∼4 s per solve per CPU yielding pre-computation times under 1 h for scalp meshes with up to 4000 faces and a parallelization factor of 5. We combine this pre-computed set of beam solutions with optical tracking, thus allowing real-time display of the tFUS beam as the operator freely navigates the transducer around the subject' scalp. We assess the impact of MBN versus line-of-sight targeting (LOST) positioning in simulations of 13 subjects. RESULTS: Our navigation tool has a display refresh rate of ∼10 Hz. In our simulations, MBN increased the acoustic dose in the thalamus and amygdala by 8-67 % compared to LOST and avoided complete target misses that affected 10-20 % of LOST cases. MBN also yielded a lower variability of the deposited dose across subjects than LOST. CONCLUSIONS: MBN may yield greater and more consistent (less variable) ultrasound dose deposition than transducer placement with line-of-sight targeting, and thus could become a helpful tool to improve the efficacy of tFUS neuromodulation.

A Novel Two-Step Method for Converting Lumbar Cortical Screw to Pedicle Screw: A Case Report.

The cortical bone trajectory (CBT) technique has emerged as a minimally invasive approach for lumbar fusion but may result in pseudoarthrosis and hardware failure. This report presents a case of successful pedicle screw revision in a patient with previous failed L2 and L3 fusion using a novel "two-step" technique, including (1) drilling a new trajectory with Medtronic EM800N Stealth MIDAS Navigated MR8 drill system (Medtronic, Dublin, Ireland) and (2) placement of Solera 4.75 ATS (awl-tapped screws) with navigated POWEREASE™ (Medtronic), described here for the first time. This method involves utilizing neuronavigation and specialized instruments to safely place pedicle screws through the path of the old cortical screw trajectory, addressing the challenges associated with CBT hardware failure.

Clinical evaluation of resection of functional area gliomas guided by intraoperative 3.0 T MRI combined with functional MRI navigation.

BACKGROUND: In assessing the clinical utility and safety of 3.0 T intraoperative magnetic resonance imaging (iMRI) combined with multimodality functional MRI (fMRI) guidance in the resection of functional area gliomas, we conducted a study. METHOD: Among 120 patients with newly diagnosed functional area gliomas who underwent surgical treatment, 60 were included in each group: the integrated group with iMRI and fMRI and the conventional navigation group. Between-group comparisons were made for the extent of resection (EOR), preoperative and postoperative activities of daily living based on the Karnofsky performance status, surgery duration, and postoperative intracranial infection rate. RESULTS: Compared to the conventional navigation group, the integrated navigation group with iMRI and fMRI exhibited significant improvements in tumor resection (complete resection rate: 85.0% vs. 60.0%, P = 0.006) and postoperative life self-care ability scores (Karnofsky score) (median ± interquartile range: 90 ± 25 vs. 80 ± 30, P = 0.013). Additionally, although the integrated navigation group with iMRI and fMRI required significantly longer surgeries than the conventional navigation group (mean ± standard deviation: 411.42 ± 126.4 min vs. 295.97 ± 96.48 min, P<0.0001), there was no significant between-group difference in the overall incidence of postoperative intracranial infection (16.7% vs. 18.3%, P = 0.624). CONCLUSION: The combination of 3.0 T iMRI with multimodal fMRI guidance enables effective tumor resection with minimal neurological damage.

Resection of meningiomas located in motor eloquent areas - comparative analysis of navigated transcranial magnetic stimulation and conventional neuronavigation.

BACKGROUND: Navigated transcranial magnetic stimulation (nTMS) has been established as a preoperative diagnostic procedure in glioma surgery, increasing the extent of resection and preserving functional outcome. nTMS motor mapping for the resection of motor eloquent meningiomas has not been evaluated in a comparative analysis, yet. METHODS: We conducted a retrospective matched-pair analysis for tumor location and size in meningioma patients with tumors located over or close to the primary motor cortex. Half of the study population received nTMS motor mapping preoperatively (nTMS-group). The primary endpoint were permanent surgery-related motor deficits. Additional factors associated with new motor deficits were evaluated apart from nTMS. RESULTS: 62 patients (mean age 62 ± 15.8 years) were evaluated. 31 patients received preoperative nTMS motor mapping. In this group, motor thresholds (rMT) corresponded with tumor location and preoperative motor status, but could not predict motor outcome. No patient with preoperative intact motor function had a surgery-related permanent deficit in the nTMS group whereas four patients in the non-TMS group with preoperative intact motor status harbored from permanent deficits. 13 patients (21.3%) had a permanent motor deficit postoperatively with no difference between the nTMS and the non-TMS-group. Worsening in motor function was associated with higher patient age (p = 0.01) and contact to the superior sagittal sinus (p = 0.027). CONCLUSION: nTMSmotor mapping did not lead to postoperative preservation in motorfunction. nTMS data corresponded well with the preoperative motorstatus and were associated with postoperative permanent deficits if tumors were located over the motor hotspot according to nTMS.

Charting the success of neuronavigation in brain tumor surgery: from inception to adoption and evolution.

PURPOSE: Neuronavigation, explored as an intra-operative adjunct for brain tumor surgery three decades ago, has become globally utilized with a promising upward trajectory. This study aims to chart its success from idea to adoption and evolution within the US and globally. METHODS: A three-pronged methodology included a systematic literature search, impact analysis using NIH relative citation ratio (RCR) and Altmetric scores, and assessment of patent holdings. Data was dichotomized for US and international contexts. RESULTS: The first neuronavigation publication stemmed from Finland in 1993, marking its inception. Over three decades, the cumulative number of 323 studies, along with the significantly increasing publication trend (r = 0.74, p < 0.05) and distribution across 34 countries, underscored its progressive and global adoption. Neuronavigation, mostly optical systems (58%), was utilized in over 19,000 cases, predominantly for brain tumor surgery (84%). Literature impact showed a robust cumulative median RCR score surpassing that for NIH-funded studies (1.37 vs. 1.0), with US studies having a significantly higher median RCR than international (1.71 vs. 1.21, p < 0.05). Technological evolution was characterized by adjuncts, including micro/exo/endoscope (21%), MRI (17%), ultrasound (10%), and CT (7%). Patent analysis demonstrated academic and industrial representation with an interdisciplinary convergence of medical and computational sciences. CONCLUSION: Since its inception thirty years ago, neuronavigation has been adopted worldwide, and it has evolved with adjunct technology integration to enhance its meaningful use. The current neuronavigation innovation pipeline is progressing, with academic and industry partnering to advance its further application in treating brain tumor patients.