A reconstruction method of cerebral surface anatomical images for image guided localization

We have developed a simple and practical method to reconstruct cerebral surface anatomical images for better presurgical planning and surgical orientation with the aid of a personal computer. The area representing the cortical surface was selected from the most superficial slice of the T1-weighted magnetic resonance (MR) images. The selected area was then overlaid upon the next superficial slice and the alignment adjusted. By repeating this procedure four to seven times we obtained a brain surface image which clearly displayed gyri and sulci. With the same method images of the vascular components of the cerebral surface were obtained from the T2-weighted images or MR angiograms. The brain surface and the vascular images were then combined to reconstruct a surface anatomical image (SAI). In addition, the outline of the lesion and natural landmarks, such as ventricles, were added if necessary. Compared to conventional surface anatomy scanning (SAS) or three-dimensional image reconstruction procedures, our method has the advantage of displaying, within a reasonable time, the manifest cortical surface from the direction of the planned surgical approach. The SAIs obtained for individual patients have proven to be useful for presurgical planning and minimizing surgical damage to the eloquent cortex in approaching both surface and subcortical lesions.