title: Use of cortical surface vessel registration for image-guided neurosurgery.
abstract: OBJECTIVE
  We have treated patients with brain surface tumors by using video registration of a three-dimensional image to the surgical field, to identify eloquent cortices, localize the lesions, and define the tumor margins. "Skin-to-skin" registration using the skin surface to produce alignment was performed earlier but was difficult in areas with few prominent registration landmarks. For this reason, "vessel-to-vessel" registration using the cortical vessels as fiducials was applied to 17 cases, to improve accuracy. This article presents the advantages and limitations of vessel-to-vessel registration, as determined from the data for these cases. The accuracy is also estimated.
  
  
  METHODS
  A three-dimensional model was reconstructed from magnetic resonance imaging data, and a two-dimensional projection was superimposed on the video image of the actual surgical field. The tumor was resected with guidance from the registered video image. The two-dimensional projection accuracy of vessel-to-vessel registration was compared with that of skin-to-skin registration by using a phantom study.
  
  
  RESULTS
  All 17 tumors underwent gross total resection, and the patients experienced no major permanent neurological deficits. In the phantom study, the two-dimensional, projected, target registration error of a tumor with skin-to-skin registration was estimated as 8.9 +/- 5.3 mm and that with vessel-to-vessel registration was 1.3 +/- 1.4 mm (99th percentile confidence intervals, 24.8 and 5.5 mm, respectively).
  
  
  CONCLUSIONS
  Video registration using cortical surface vessels is practical and improves two-dimensional projection accuracy significantly, compared with skin registration.
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: S
authors.initials: S
authors.lastname: Nakajima
authors.forename: H
authors.initials: H
authors.lastname: Atsumi
authors.forename: R
authors.initials: R
authors.lastname: Kikinis
authors.forename: T M
authors.initials: TM
authors.lastname: Moriarty
authors.forename: D C
authors.initials: DC
authors.lastname: Metcalf
authors.forename: F A
authors.initials: FA
authors.lastname: Jolesz
authors.forename: P M
authors.initials: PM
authors.lastname: Black
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001158:Arteries / Q000473:pathology; D001932:Brain Neoplasms / Q000098:blood supply / Q000175:diagnosis / Q000601:surgery*; D002540:Cerebral Cortex / Q000098:blood supply* / Q000601:surgery; D004867:Equipment Design; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D011183:Postoperative Complications / Q000209:etiology; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D014741:Video Recording / Q000295:instrumentation*