Visualization and navigation system development and application for stereotactic deep-brain neurosurgeries

Abstract

We present the development of a visualization and navigation system and its application in pre-operative planning and intra-operative guidance of stereotactic deep-brain neurosurgical procedures for the treatment of Parkinson's disease, chronic pain, and essential tremor. This system incorporates a variety of standardized functional and anatomical information, and is capable of non-rigid registration, interactive manipulation, and processing of clinical image data. The integration of a digitized and segmented brain atlas, an electrophysiological database, and collections of final surgical targets from previous patients facilitates the delineation of surgical targets and surrounding structures, as well as functional borders. We conducted studies to compare the surgical target locations identified by an experienced stereotactic neurosurgeon using multiple electrophysiological exploratory trajectories with those located by a non-expert using this system on 70 thalamotomy, pallidotomy, thalamic deep-brain stimulation (DBS), and subthalamic nucleus (STN) DBS procedures. The average displacement between the surgical target locations in both groups was 1.95 +/- 0.86 mm, 1.83 +/- 1.07 mm, 1.88 +/- 0.89 mm and 1.61 +/- 0.67 mm for each category of surgeries, respectively, indicating the potential value of our system in stereotactic deep-brain neurosurgical procedures, and demonstrating its capability for accurate surgical target initiation.

Stereotactic implantation of deep brain stimulation electrodes: a review of technical systems, methods and emerging tools

“…The StimPilot Software (Medtronic Inc., Minneapolis, MN) [53] allowed a combined visualisation of short MER recordings together with the anatomical information but it is only commercialised in the US. Only few groups use homemade software for online data collection and visualisation [24,41,77]. Most of them use electrophysiological databases of several patients taking into account MER and rarely as well test stimulation results which are non-rigidly registered to the patient's MRI in order to predict preoperative target points.…”

Fusion and visualization of intraoperative cortical images with preoperative models for epilepsy surgical planning and guidance

“…fMRI images were processed with SPM2 [22] using a general linear model to generate the functional maps that are represented by areas activated by the language tasks. Next, the MRI and fMRI image data were first registered to each other, and were then in turn registered to the CT image using AtamaiWarp [23,24]. The registered CT volume, MR volume and fMRI activation maps were then displayed using volume rendering, in which different color transfer functions were applied to each modality image and the final fused image rendered using a composite blending technique.…”

Surgical targeting accuracy analysis of six methods for subthalamic nucleus deep brain stimulation

“…This comprehensive neurosurgical system readily accommodates inter-subject anatomical variability by the use of a fast 3D non-rigid image registration approach, AtamaiWarp [32]. In addition to a variety of anatomical references, such as the digitized and segmented Schaltenbrand and Wahren brain atlas [9] and high resolution and high SNR quantitative T 1 and T 2 maps [18,19], our visualization and navigation system also incorporates functional references, including 3D electrophysiological databases [25] and collections of actual surgical targets from previous patients. This system is capable of not only interactively displaying the linked patient image and standard brain template, reformatting them along arbitrary axes, but also registering and fusing images from different imaging modalities, digitized brain atlases, and functional data with the pre-operative patient images.…”

“…Surgical target localization with the six targeting procedures evaluated in this paper was conducted using a neurosurgical visualization and navigation system [25], which is integrated with normalized functional and anatomical information within the standard brain space defined by the Colin27 volume. This comprehensive neurosurgical system readily accommodates inter-subject anatomical variability by the use of a fast 3D non-rigid image registration approach, AtamaiWarp [32].…”

“…In addition, registered surgical targets from previous patients [24], as well as integration of multiple functional and anatomical references [25,26], may also be employed to facilitate STN DBS surgical targeting. Although the STN is often distinguishable on patient-specific T 2 -weighted MR images, which allow better visualization of this nucleus, the discrepancy between the target positions localized with T 2 -weighted MR images and those finalized using electrophysiological measurements should be taken into consideration, and the use of T 2 -weighted MR images alone should be employed cautiously [27,28].…”