Objective-The usefulness of neurosurgical navigation with current visualizations is seriously compromised by brain shift, which inevitably occurs during the course of the operation, significantly degrading the precise alignment between the preoperative MR data and the intraoperative shape of the brain. Our objectives were (i) to evaluate the feasibility of non-rigid registration that compensates for the brain deformations within the time constraints imposed by neurosurgery, and (ii) create augmented reality visualizations of critical structural and functional brain regions during neurosurgery using pre-operatively acquired fMRI and DT-MRI.Materials and Methods-Eleven consecutive patients with supratentorial gliomas were included in our study. All underwent surgery at our intra-operative MR imaging-guided therapy facility and have tumors in eloquent brain areas (e.g. precentral gyrus and cortico-spinal tract). Functional MRI and DT-MRI, together with MPRAGE and T2w structural MRI were acquired at 3T prior to surgery. SPGR and T2w images were acquired with a 0.5T magnet during each procedure. Quantitative assessment of the alignment accuracy was carried out and compared with current state-of the-art systems based only on rigid-registration.Results-Alignment between preoperative and intra-operative datasets was successfully carried out during surgery for all patients. Overall, the mean residual displacement remaining after nonrigid registration was 1.82 mm. There is a statistically significant improvement in alignment accuracy utilizing our non-rigid registration in comparison to the currently used technology (p<0.001).Conclusions-We were able to achieve intra-operative rigid and non-rigid registration of (1) pre-operative structural MRI with intra-operative T1w MRI; (2) pre-operative FMRI with intraoperative T1w MRI, and (3) pre-operative DT-MRI with intra-operative T1w MRI. The registration algorithms as implemented were sufficiently robust and rapid to meet the hard realtime constraints of intra-operative surgical decision making. The validation experiments demonstrate that we can accurately compensate for the deformation of the brain and thus can construct an augmented reality visualization to aid the surgeon.

An inherent drawback of the traditional diffusion tensor model is its limited ability to provide detailed information about multidirectional fiber architecture within a voxel. This leads to erroneous fiber tractography results in locations where fiber bundles cross each other. This may lead to the inability to visualize clinically important tracts such as the lateral projections of the corticospinal tract. In this report, we present a deterministic two-tensor eXtended Streamline Tractography (XST) technique, which successfully traces through regions of crossing fibers. We evaluated the method on simulated and in vivo human brain data, comparing the results with the traditional single-tensor and with a probabilistic tractography technique. By tracing the corticospinal tract and correlating with fMRIdetermined motor cortex in both healthy subjects and patients with brain tumors, we demonstrate that two-tensor deterministic streamline tractography can accurately identify fiber bundles consistent with anatomy and previously not detected by conventional single tensor tractography. When compared to the dense connectivity maps generated by probabilistic tractography, the method is computationally efficient and generates discrete geometric pathways that are simple to visualize and clinically useful. Detection of crossing white matter pathways can improve neurosurgical visualization of functionally relevant white matter areas.

The present study examined the relationship between hand preference degree and direction, functional language lateralization in Broca's and Wernicke's areas, and structural measures of the arcuate fasciculus. Results revealed an effect of degree of hand preference on arcuate fasciculus structure, such that consistently-handed individuals, regardless of the direction of hand preference, demonstrated the most asymmetric arcuate fasciculus, with larger left versus right arcuate, as measured by DTI. Functional language lateralization in Wernicke's area, measured via fMRI, was related to arcuate fasciculus volume in consistent-left-handers only, and only in people who were not right hemisphere lateralized for language; given the small sample size for this finding, future investigation is warranted. Results suggest handedness degree may be an important variable to investigate in the context of neuroanatomical asymmetries. KeywordsHandedness; language; arcuate fasciculus; FMRI; DTI There are well-known hemispheric asymmetries in human neuroanatomy and in cognitive processing. Investigations of patient and non-patient populations have repeatedly demonstrated that the left and right hemispheres (LHem and RHem) differ in their structures (e.g.: in the size, location, and/or shape of different areas) and in their information processing abilities (see Cabeza & Nyberg, 2000;Gazzaniga, 2000;Hellige, 2001).Some of the most frequently investigated hemispheric asymmetries involve language. Functionally, in the majority of humans, speech production and language comprehension are primarily LHem phenomena (e.g., Cabeza & Nyberg 2000;Knecht et al., 2000a;© 2009 Elsevier Inc. All rights reserved. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Papathanassiou et al., 2000; see also Hellige, 2001). Similarly, and again in the majority of the population, neuroanatomic structures known to be involved in language functions are larger or more pronounced in the LHem, compared to the RHem. For example, the planum temporale, the pars opercularis, and the pars triangularis are larger, and the sylvian fissure longer, in the LHem relative to the RHem (Dorsaint-Pierre et al., 2006;Foundas, Leonard, Gilmore, Fennell, & Heilman, 1996;Shapleske et al., 1999; see Hellige, 2001 for extensive review). NIH Public AccessDespite the clear LHem bias in the processing of language information and in the neuroanatomical structures involved in language, the relationship between a given neuroanatomical structure and functional language lateralization remains unclear. For example, do any particular neuroanatomic...