Intraoperative image fusion to ascertain adequate lead placement

Area of Science:

• Neurosurgery
• Medical Imaging
• Neurological Devices

Background:

• Intraoperative visualization of deep brain stimulator (DBS) lead placement is crucial for accurate targeting.
• High-resolution 3-tesla magnetic resonance (3T-MR) imaging offers detailed anatomical views.
• Fusing intraoperative computed tomography (CT) with preoperative 3T-MR images can provide real-time lead position assessment.

Purpose of the Study:

• To describe and discuss a method for fusing intraoperative CT images with preoperative 3T-MR images.
• To enable visualization of DBS lead position relative to the stereotactic target during surgery.
• To facilitate intraoperative correction of lead placement errors.

Main Methods:

• The described method was applied to 8 DBS procedures (6 subthalamic nucleus, 2 ventral-intermediate nucleus).
• Intraoperative CT images were acquired on the CT table in a stereotactic frame.
• CT and MR images were fused, and lead position was verified against the Schaltenbrand atlas coordinates.

Main Results:

• The fusion method allowed for intraoperative visualization of DBS lead position on 3T-MR images.
• Lead placement errors in the x-coordinate were detected in 2 patients.
• These detected errors were successfully corrected prior to the conclusion of the procedures.

Conclusions:

• The described method is a simple and effective way to intraoperatively visualize DBS lead position.
• This technique enhances surgical accuracy by allowing for real-time error detection and correction.
• The ability to correct lead placement errors intraoperatively improves patient outcomes in DBS surgery.