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 intraoperative 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.

Multimodal Imaging and Image Analysis Techniques for Neuromodulation

“…Collectively, they represent a functional atlas of points that can be used to predict surgical trajectories and the probability of successful target localization. Subsequent work has expanded that the amount of intraoperative electrophysiological data has been included in their electrophysiological database (Guo, Finnis, Parrent, & Peters, 2006;Guo et al, 2007b). Other groups have taken this approach and mapped the spatial distribution of the mean STN spike rate on a template that reflects the average neuroanatomy of a set of preoperative candidates (D'Haese, Cetinkaya, Konrad, Kao, Dawant, 2005;D'Haese, Pallavaram, et al, 2005).…”

PyDBS: an automated image processing workflow for deep brain stimulation surgery

“…The study by Guo et al [5] has presented a visualization and navigation system for stereotactic DBS procedures.…”

“…By means of a standard-angle approach, the system provides pre-computed implantation plans that can be modified or validated by the surgeon. CranialVault and the CRAVE tools also include an intraoperative module with similar features to those implemented in the first two studies mentioned [5,6], along with a postoperative module for electrode contact detection.…”

Anatomo-clinical atlases correlate clinical data and electrode contact coordinates: Application to subthalamic deep brain stimulation

“…This fusion of clinical and anatomical information allows an understanding of functional organization within deep-brain structures that helps in the identification of the optimal therapy zone for further patients. Finnis et al (2003) and Guo et al (2006) proposed probabilistic functional atlases by integrating intra-operative recordings. D'Haese et al (2005D'Haese et al ( , 2006 and Pallavaram et al (2008Pallavaram et al ( , 2009 proposed a system to automatically predict the optimum target position according to atlases built from retrospective studies.…”

“…While most of these atlases use a single motor score for modelling the global outcome of the patient (e.g. Guo et al, 2006), we proposed in this paper to extend this research by adding pre-and post-operative motor, cognitive and neuropsychological scores of patients with Parkinson's disease and inclusion criteria for subthalamic stimulation. We thus introduce the concept of anatomo-clinical atlases and describe the methods for their computation.…”