Skip to main content

16.03.2019 | Original Article - Neurosurgery general | Ausgabe 5/2019 Open Access

Acta Neurochirurgica 5/2019

Current accuracy of surface matching compared to adhesive markers in patient-to-image registration

Acta Neurochirurgica > Ausgabe 5/2019
Mireli A. Mongen, Peter W. A. Willems
Wichtige Hinweise
This article is part of the Topical Collection on Neurosurgery general


This is a nice study, which compares the accuracy of the registration with surface matching technique and point-pair matching (stickers/fiducials) and its influence on Target Registration Error (TRE). The authors demonstrated that the surface matching is inferior to the point-pair matching technique. Furthermore, there is no correlation of the TRE with the ERA (estimated registration accuracy). It means that low ERA provided by a neuronavigation system does not guarantee improved accuracy for the target location (TRE). There was no difference on comparison of 3 modern neuronavigation systems (S7, S8 and Curve). And, which is more disappointing - the "improvement attempt" offered by Brainlab Curve, practically worsened the TRE. Although the study was performed on small series, the data reached statistical significance.
The paper is well and clearly written. It is a very useful reminder to the neurosurgeons about hidden pitfalls which may exist in a routine and seemingly precise process such as the use of neuronavigation.
Sergey Spektor
Jerusalem, Israel

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.



In the past, the accuracy of surface matching has been shown to be disappointing. We aimed to determine whether this had improved over the years by assessing application accuracy of current navigation systems, using either surface matching or point-pair matching.


Eleven patients, scheduled for intracranial surgery, were included in this study after a power analysis had shown this small number to be sufficient. Prior to surgery, one additional fiducial marker was placed on the scalp, the “target marker,” where the entry point of surgery was to be expected. Using one of three different navigation systems, two patient-to-image registration procedures were performed: one based on surface matching and one based on point-pair matching. Each registration procedure was followed by the digitization of the target marker’s location, allowing calculation of the target registration error. If the system offered surface matching improvement, this was always used; and for the two systems that routinely offer an estimate of neuronavigation accuracy, this was also recorded.


The error in localizing the target marker using point-pair matching or surface matching was respectively 2.49 mm and 5.35 mm, on average (p < 0.001). In those four cases where an attempt was made to improve the surface matching, the error increased to 6.35 mm, on average. For the seven cases where the system estimated accuracy, this estimate did not correlate with target registration error (R2 = 0.04, p = 0.67).


The accuracy of navigation systems has not improved over the last decade, with surface matching consistently yielding errors that are twice as large as when point-pair matching with adhesive markers is used. These errors are not reliably reflected by the systems own prediction, when offered. These results are important to make an informed choice between image-to-patient registration strategies, depending on the type of surgery at hand.

Unsere Produktempfehlungen

e.Med Interdisziplinär


Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf Zusätzlich können Sie eine Zeitschrift Ihrer Wahl in gedruckter Form beziehen – ohne Aufpreis.

Jetzt e.Med bestellen und 100 € sparen!

e.Med Neurologie & Psychiatrie


Mit e.Med Neurologie & Psychiatrie erhalten Sie Zugang zu CME-Fortbildungen der Fachgebiete, den Premium-Inhalten der dazugehörigen Fachzeitschriften, inklusive einer gedruckten Zeitschrift Ihrer Wahl.

e.Med Neurologie


Mit e.Med Neurologie erhalten Sie Zugang zu CME-Fortbildungen des Fachgebietes, den Premium-Inhalten der neurologischen Fachzeitschriften, inklusive einer gedruckten Neurologie-Zeitschrift Ihrer Wahl.

Weitere Produktempfehlungen anzeigen
Über diesen Artikel

Weitere Artikel der Ausgabe 5/2019

Acta Neurochirurgica 5/2019 Zur Ausgabe

Technical Note - Functional Neurosurgery - Epilepsy

Three-dimensional neuronavigation in SEEG-guided epilepsy surgery

Neu im Fachgebiet Chirurgie

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Chirurgie und bleiben Sie gut informiert – ganz bequem per eMail.