Elsevier

NeuroImage

Volume 37, Supplement 1, 2007, Pages S109-S115
NeuroImage

Review
Brain mapping in stereotactic surgery: A brief overview from the probabilistic targeting to the patient-based anatomic mapping

https://doi.org/10.1016/j.neuroimage.2007.05.055Get rights and content

Abstract

In this article, we briefly review the concept of brain mapping in stereotactic surgery taking into account recent advances in stereotactic imaging. The gold standard continues to rely on probabilistic and indirect targeting, relative to a stereotactic reference, i.e., mostly the anterior (AC) and the posterior (PC) commissures. The theoretical position of a target defined on an atlas is transposed into the stereotactic space of a patient’s brain; final positioning depends on electrophysiological analysis. The method is also used to analyze final electrode or lesion position for a patient or group of patients, by projection on an atlas. Limitations are precision of definition of the AC–PC line, probabilistic location and reliability of the electrophysiological guidance. Advances in MR imaging, as from 1.5-T machines, make stereotactic references no longer mandatory and allow an anatomic mapping based on an individual patient’s brain. Direct targeting is enabled by high-quality images, an advanced anatomic knowledge and dedicated surgical software. Labeling associated with manual segmentation can help for the position analysis along non-conventional, interpolated planes. Analysis of final electrode or lesion position, for a patient or group of patients, could benefit from the concept of membership, the attribution of a weighted membership degree to a contact or a structure according to its level of involvement. In the future, more powerful MRI machines, diffusion tensor imaging, tractography and computational modeling will further the understanding of anatomy and deep brain stimulation effects.

Introduction

Brain mapping in the classical meaning of stereotactic surgery is based on intra operative electrophysiological recordings in order to locate, for a given patient, the so-called invisible targets. Since the pioneering days, the stereotactic targeting was indirect because the targets were de facto arranged in areas relative to ventricular baselines as imaging techniques failed to show the internal anatomy of the brain (Talairach et al., 1957). For most of the deep brain structures, basal ganglia, internal subdivision of thalamus and main white bundles, a reference position in relation to ventricular landmarks was proposed based on anatomic specimen studies transcribed in stereotactic atlases (Talairach et al., 1957, Schaltenbrand and Bailey, 1959). Nowadays in spite of considerable progresses in magnetic resonance imaging (MRI), few surgical teams have shifted to pure direct anatomic targeting with neither ventricular baselines and/or atlas matching nor neuronal activity recordings (Lemaire et al., 1999, Caire et al., 2006, Plaha et al., 2006). This direct targeting concept depends exclusively on the visualization of the detailed internal anatomy of each patient’s brain providing a personal MRI map. Here, we briefly review the concept of brain mapping in stereotactic surgery by indirect and direct methods of targeting, in light of recent advances in stereotactic MRI.

Section snippets

The indirect probabilistic targeting

The gold standard in classical stereotactic surgery relies worldwide on indirect probabilistic targeting, relative to a stereotactic reference. Historically ventricle landmarks represented this reference because X-ray ventriculography (intraventricular injection of an iodized contrast agent and/or the air) was the only technique visualizing the gross internal brain morphology. With the advent of slice (computerized tomography, CT and MR) imaging, the method has shifted without redefinition of

The “direct” patient-based anatomic mapping in stereotactic surgery

In order to improve the surgical stereotactic method, since targets become more visible with new MRI modalities (hardware and software), a stereotactic reference is not mandatory anymore; the patient’s brain is its own reference, a direct patient-based anatomic mapping gets rational as from 1.5 T (Lemaire et al., 1999, Coubes et al., 2002, Plaha et al., 2006, Derost et al., 2007). Some teams use transitional methods, locating targets with reference to easy recognizable structures, like the red

Future trends

Patient-based anatomic mapping should benefit from higher magnetic field, although beyond 3 T there are still important technical constraints preventing a routine clinical use, in particular in stereotactic conditions. But as from 1.5 T, diffusion tensor imaging (DTI) and tractography already offer new possibilities. These techniques enable the analysis of the anisotropy of brain tissue as well as fibbers constituting white bundles (Mori et al., 1999, Mori and Van Zijl, 2002, Le Bihan, 2003,

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