A Low-Cost Articulated Arm Navigation System for External Ventricular Drain Placement

Objective: This paper proposes a low-cost real-time navigation system to assist a surgeon in placing external ventricular drains. Methods: In our approach, the base of an articulated arm coordinate measuring machine is bolted to the patient’s skull, and a graphical user interface quickly guides the operator through the image registration and 3D navigation to place an external ventricular drain at a desired target specified relative to preoperative imaging. The method can be employed in workflows with and without fiducials embedded in the preoperative imaging. Results: The proposed system is evaluated using precise registration instruments, human phantom models, and ex vivo ovine models, demonstrating less than 2 mm of error with fiducials and less than 4 mm of error without fiducials. Conclusion: The registration procedure takes less than one minute and can be performed intuitively by a single operator without an assistant. Significance: Our proposed system enables real-time image-guided navigation to be used in bedside external ventricular drain placement, with potential to expand access to this procedure.