Classical and real-time neuronavigation in pediatric neurosurgery

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. 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. In this article, we review the main neuronavigation systems and their applications, emphasizing their unique advantages and usage within the pediatric population.