title: Computer-aided placement of deep brain stimulators: from planning to intraoperative guidance.
abstract: In current practice, optimal placement of deep-brain stimulators (DBSs) used to treat movement disorders in patients with Parkinson's disease and essential tremor is an iterative procedure. A target is chosen preoperatively based on anatomical landmarks identified on magnetic resonance images. This point is used as an initial position that is refined intraoperatively using both microelectrode recordings and macrostimulation. In this paper, we report on our current progress toward developing a system for the computer-assisted preoperative selection of target points and for the intraoperative adjustment of these points. The system consists of a deformable atlas of optimal target points that can be used to select automatically the preoperative target, of an electrophysiological atlas, and of an intraoperative interface. Results we have obtained show that automatic prediction of target points is an achievable goal. Our results also indicate that electrophysiological information could be used to resolve structures not visible in anatomic images, thus improving both preoperative and intraoperative guidance. Our intraoperative system has reached the stage of a working prototype and we compare targeting accuracy as well as the number of paths needed to reach the targets with our system and with the method in current clinical use.
authors.affiliation: Department of Electrical Engineering, Catholic University of Louvain (UCL), Louvain, Belgium. pierre-francois.dhaese@vanderbilt.edu
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: D'Haese
authors.forename: Ebru
authors.initials: E
authors.lastname: Cetinkaya
authors.forename: Peter E
authors.initials: PE
authors.lastname: Konrad
authors.forename: Chris
authors.initials: C
authors.lastname: Kao
authors.forename: Benoit M
authors.initials: BM
authors.lastname: Dawant
mesh_terms: D000465:Algorithms; D001185:Artificial Intelligence; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007430:Intraoperative Care / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D019919:Prosthesis Implantation / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014584:User-Computer Interface