title: Brain mapping in stereotactic surgery: a brief overview from the probabilistic targeting to the patient-based anatomic mapping.
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.
authors.affiliation: CHU Clermont-Ferrand, Hôpital Gabriel Montpied, Service de Neurochirurgie A, Clermont-Ferrand, F-63003, France. jjlemaire@chu-clermontferrand.fr
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Lemaire
authors.forename: Jérôme
authors.initials: J
authors.lastname: Coste
authors.forename: Lemlih
authors.initials: L
authors.lastname: Ouchchane
authors.forename: François
authors.initials: F
authors.lastname: Caire
authors.forename: Christophe
authors.initials: C
authors.lastname: Nuti
authors.forename: Philippe
authors.initials: P
authors.lastname: Derost
authors.forename: Vittorio
authors.initials: V
authors.lastname: Cristini
authors.forename: Jean
authors.initials: J
authors.lastname: Gabrillargues
authors.forename: Simone
authors.initials: S
authors.lastname: Hemm
authors.forename: Franck
authors.initials: F
authors.lastname: Durif
authors.forename: Jean
authors.initials: J
authors.lastname: Chazal
mesh_terms: D001921:Brain / Q000033:anatomy & histology* / Q000502:physiology*; D001931:Brain Mapping / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008959:Models, Neurological; D015233:Models, Statistical; D019635:Neurosurgical Procedures; D013238:Stereotaxic Techniques