Ahead of Print: Real-Time Atlas-Based Stereotactic Neuronavigation

Screen Shot 2013-10-09 at 2.27.38 PMBackground: Surgery for tumors in eloquent brain faces immense challenges when attempting to maximize resection and avoid neurological deficits.

Objective: In order to give the surgeon real-time atlas-based anatomical information linked to the patient’s anatomy, we developed a software-based interface between deformable anatomical templates (DAT) and an intra-operative navigation system.

Methods: Magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) and/or functional MRI (fMRI) were performed on 3 patients pre-operatively for the purposes of tumor resection using neuronavigation. The DAT was registered to the patients’ navigation coordinate system and utilized coordinates from the navigation system during surgery. This provided the surgeon with a list of proximal anatomical and functional structures and a real-time image of the atlas at that location fused to the patients’ MRI. The clinical feasibility of this approach was evaluated during resection of three eloquent tumors (right post-central gyrus, left inferior frontal gyrus, and left occipital cuneus gyrus).

Results: Tumor resection was performed successfully in all three patients. Using the coordinates from the navigation system, anatomical and functional structures and their distances were visualized interactively during tumor resection using the DAT.

Conclusion: This is a proof of concept that an interactive atlas-based navigation can provide detailed anatomical and functional information that supplements MRI, DTI, and fMRI. The atlas-based navigation generated distances to important anatomic structures from the navigation probe tip. It can be used to guide direct electrical stimulation and highlight areas to avoid during tumor resection.

From: Real-Time Atlas-Based Stereotactic Neuronavigation by Prabhu et al.

Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.