Computer-aided stereotactic functional neurosurgery enhanced by the use of the multiple brain atlas database

Abstract

This paper introduces a computer-aided atlas-based functional neurosurgery methodology and describes NeuroPlanner, a software system which supports it. NeuroPlanner provides four groups of functions: 1) data-related for data reading, interpolation, reformatting, and image processing; 2) atlas-related for multiple atlases reading, atlas-to-data global and local registrations, two-way anatomical indexing, and multiple labeling in two and three dimensions; 3) atlas-data exploration-related for three-dimensional (3-D) display and real-time manipulation of cerebral structures, continuous navigation, two-dimensional (2-D), triplanar, 3-D presentations, and 2-D interaction in four views; and 4) neurosurgery-related for targeting, trajectory planning, mensuration, simulating the insertion of microelectrode, and simulating therapeutic lesioning. All operations, excluding atlas and data reading, are real time. The combined anatomical index of the multiple brain atlas database containing complementary 2-D and 3-D atlases has about 1000 structures per hemisphere, and over 400 sulcal patterns. Neurosurgical planning with mutually preregistered multiple brain atlases in all three orthogonal orientations is novel. The approach is validated with 24 intraoperative and postoperative datasets for thalamotomies, thalamic stimulations, pallidotomies, and pallidal stimulations. Its potential benefits include increased accuracy of target definition, reduced time of the surgical procedure by decreasing the number of tracts, facilitated planning of more sophisticated trajectories, lowered cost by reducing the number of microelectrodes used, reduced surgical complications, and the extra degree of confidence given to the neurosurgeon.

Generation of Individualized Thalamus Target Maps by Using Statistical Shape Models and Thalamocortical Tractography

“…[1][2][3] Various methods have been developed to map, organize, and use the prior topographic information of thalamic subdivisions that are provided by anatomic stereotactic atlases. [4][5][6][7][8] In parallel to the effort of providing stereotactic atlases that incorporate clinical imaging-based anatomic correspondences, 9 it is desirable to optimize MR imaging sequences and image-processing techniques for the direct identification of thalamic nuclei. [10][11][12] A promising technique to noninvasively chart the human thalamus is diffusion tensor imaging 13 and subsequent probabilistic tractography, which can be applied to map the networks of thalamocortical connectivity.…”

Automatic Trajectory Planning of DBS Neurosurgery from Multi-modal MRI Datasets

“…Ventricles are automatically segmented from the T1w dataset using a standard tissue classification method [14]. 4. Avoid blood vessels.…”

“…Some software tools [3][4] were proposed to simulate the surgical insertion and automatically detect intersected structures, but the entry point selection remains empirical. Many methods encode critical structures once in an atlas [5][6][7] although recent methods favor direct segmentation in the native patient datasets to better account for inter-subject variability, especially for important structures such as sulci and blood vessels.…”

Automatic Trajectory Planning for Deep Brain Stimulation: A Feasibility Study

“…Many of the existing planning algorithms require manual selection of entry points, for example those of Nowinski et al [2] and Lee et al [3]. Some only visualize the resulting path, others can also render target lesions and virtual tools.…”