Optimizing accuracy in magnetic resonance imaging-guided stereotaxis: a technique with validation based on the anterior commissure-posterior commissure line.
OBJECTIVE
Some of the earliest successful frame-based stereotactic interventions directed toward the thalamus and basal ganglia depended on identifying the anterior commissure (AC) and posterior commissure (PC) in a sagittal ventriculogram and defining the intercommissural line that connects them in the midsagittal plane. The AC-PC line became the essential landmark for the localization of neuroanatomical targets in the basal ganglia and diencephalon and for relating them to stereotactic atlases. Stereotactic/functional neurosurgery has come to rely increasingly on magnetic resonance (MR) imaging guidance, and methods for accurately determining the AC-PC line on MR imaging are being developed. The goal of the present article is to present the authors' technique.


METHODS
The technique described uses MR sequences that minimize geometric distortion and registration error, thereby maximizing accuracy in AC-PC line determinations from axially displayed MR data. The technique is based on the authors' experience with the Leksell G-frame but can be generalized to other MR imaging-based stereotactic systems. This methodology has been used in a series of 62 stereotactic procedures in 47 adults (55 pallidotomies and seven thalamotomies) with preliminary results that compare favorably with results reported when using microelectrode recordings. The measurements of the AC-PC line reported here also compare favorably with those based on ventriculography and computerized tomography scanning.


CONCLUSIONS
The methodology reported here is critical in maintaining the accuracy and utility of MR imaging as its role in modern stereotaxy expands. Accurate parameters such as these aid in ensuring the safety, efficacy, and reproducibility of MR-guided stereotactic procedures.
Department of Neurosurgery, University of Virginia, Charlottesville 22908, USA. cgd@virginia.edu
C G
CG
diPierro
P C
PC
Francel
T R
TR
Jackson
T
T
Kamiryo
E R
ER
Laws
D000328:Adult; D001479:Basal Ganglia / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery; D014695:Cerebral Ventriculography; D003287:Contrast Media; D003626:Data Display; D004027:Diencephalon / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D005917:Globus Pallidus / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008839:Microelectrodes; D010347:Patient Care Planning; D019047:Phantoms, Imaging; D015642:Radiology, Interventional; D015203:Reproducibility of Results; D012449:Safety; D013238:Stereotaxic Techniques; D013788:Thalamus / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed
D003287:Contrast Media