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Computer-aided placement of deep brain stimulators: from planning to intraoperative guidance

The long term objective of our research is to develop a system that will automate as much as possible DBS implantation procedures. It is estimated that about 180,000 patients/year would benefit from DBS implantation. Yet, only 3000 procedures are performed annually. This is so because the combined expertise required to perform the procedure successfully is only available at a limited number of sites. Our goal is to transform this procedure into a procedure that can be performed by a general neurosurgeon at a community hospital. In this work we report on our current progress toward developing a system for the computer-assisted pre-operative selection of target points and for the intra-operative adjustment of these points. The system consists of a deformable atlas of optimal target points that can be used to select automatically the pre-operative target, of an electrophysiological atlas, and of an intra-operative interface. The atlas is deformed using a rigid then a non-rigid registration algorithm developed at our institution. Results we have obtained show that automatic prediction of target points is an achievable goal. Our results also indicate that electrophysiological information can be used to resolve structures not visible in anatomic images, thus improving both pre-operative and intra-operative guidance. Our intra-operative system has reached the stage of a working prototype that is clinically used at our institution.