Stereotactic neurosurgery using 3-D image data from computed tomography.

Abstract

During the last decade computer tomography (CT) scanners have provided images that show internal anatomy of unsurpassed resolution and that, since they are inherently digital, a format computer graphics software can easily process. By combining CT images, a specially designed head-mounted instrument, and the software to coordinate them, improved surgical accuracy can result for stereotactic surgery. Using the head-mounted frame and the interactive computer software described here, the entire stereotactic approach is transportable to computer systems of three major CT manufacturers. Neurosurgeons now have a tool that allows trajectory selection and probe placement entirely within the CT suite. Compared with conventional stereotaxis, the CT-aided approach offers increased accuracy, with a significant fluid contrast injection for finding reference points and the avoidance of important brain structures due to the direct visualization afforded with CT. Key interactive features are shown here that allow unrestricted views of anatomy in the area of surgical interest. For example, oblique views that are normal to the trajectory of neurosurgical instruments are extracted in real time during the surgical procedure. Standard sagittal (lateral) and coronal (frontal) image planes are also shown integrated with the interactive technique. The surgical procedure is outlined and details of the pattern recognition technique for image-to-frame registration are presented. Test, phantom, and patient results are given.