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

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-relate d for multiple atlases reading, atlas-to-data global and local registration s, two-way anatomical indexing, and multiple labeling in two and three dime nsions; 3) atlas-data exploration-related for three-dimensional (3-D) displ ay 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 planni ng, mensuration, simulating the insertion of microelectrode, and simulating therapeutic lesioning, All operations, excluding atlas and data reading, a re real time. The combined anatomical index of the multiple brain atlas dat abase containing complementary 2-D and 3-D atlases has about 1000 structure s per hemisphere, and over 400 sulcal patterns. Neurosurgical planning with mutually preregistered multiple brain atlases i n all three orthogonal orientations is novel. The approach is validated wit h 24 intraoperative and postoperative datasets For thalamotomies, thalamic stimulations, pallidotomies, and pallidal stimulations. Its potential benefits include increased accuracy of target definition, red uced time of the surgical procedure by decreasing the number of tracts, fac ilitated planning of more sophisticated trajectories, lowered cost by reduc ing the number of microelectrodes used, reduced surgical complications, and the extra degree of confidence given to the neurosurgeon.