Precision in Neuronavigation Systems: A Systematic Review and Meta-analysis

Introduction To evaluate the accuracy of different neuronavigation systems and establish factors that influence their accuracy and their indications for use. Methods This is a systematic review of the literature with meta-analysis based on the guiding question of the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA): What is the accuracy of neuronavigation systems and the factors that influence it? For that, a search was performed in PubMed, LILACS, SciELO, Embase, Web of Science, and SCOPUS databases using descriptors combined with two Boolean operators. The articles found were submitted to eligibility criteria, and the reading was partial and complete. A total of 51 studies were selected, and 11 were included in the meta-analysis. Results In total, 5,316 procedures were evaluated using neuronavigation systems and different types of procedures performed on the skull and spine. After meta-analysis, it was possible to establish the accuracy of the optical (N = 297) and AR (N = 195), with SBT of 2.34 mm and 2.09 mm, respectively. However, studies were evaluated regarding the influence of different recording methods, the use of associated technologies, and their indications for use. Conclusions The accuracy of the systems was established through the TRE of 2.34 mm for the optical and 2.09 mm for the augmented reality, while it was not possible to establish the electromagnetic one. Thus, the ARN is the system with the best accuracy value, in addition to presenting advantages during the surgical period when compared with the others.