Fiducials: Achilles' heel of image-guided neurosurgery: an attempt at indigenization and improvement.

Abstract

Image-guided surgery or neuronavigation has become an important part of the neurosurgical armamentarium in most centers around the world, primarily because it helps to improve patient safety and consistency of surgical results.1–5,8 However, these advantages come at the cost of increased health care and patient expenses. The disposable products used in image-guided surgery are often very costly. In developing countries such as India, hospitals may find money for large capital purchases, but often fail to budget for the price of consumables over the lifetime of the product. The lack of availability of the consumables may lead to underuse of the equipment. At the All India Institute for Medical Sciences, the Medtronic StealthStation (Medtronic Sofamor Danek, Inc., Memphis, TN) is used for neuronavigation, and the disposable fiducials cost INR4200 (US$100) for every procedure in which the StealthStation is used. As the average cost of consumables in major cranial surgery at our center is INR15000 (US$350), using neuronavigation can increase these costs by 25% simply because of the cost of fiducials. We therefore attempted to find less expensive available indigenous alternatives to replace the proprietary fiducials used with the StealthStation in image-guided neurosurgery.