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

Objective: This paper proposes a low-cost realtime 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 patients 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 2mm of error with fiducials and less than 4mm 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.