Classical and real-time neuronavigation in pediatric neurosurgery

Introduction: Neuronavigation has become a cornerstone of neurosurgery. Navigation systems are categorized into two main groups: those based on preoperative imaging and those based on real-time intraoperative acquired images. Objectives: The preoperative imaging systems, either computed tomography (CT)- or magnetic resonance imaging (MRI)-based, are straight-forward systems that are routinely used in most institutions. Image accuracy, however, decreases secondary to brain and lesion shifts that occur during surgery. Intraoperative, real-time navigation systems overcome anatomical shifts by updating the image base of the navigation during surgery, thus, maintaining precise navigation capabilities throughout the surgical procedure. Conclusions: In this article, we review the main neuronavigation systems and their applications, emphasizing their unique advantages and usage within the pediatric population.