Abstracts

Rationale: Image-guided surgery systems are beginning to revolutionize surgical practice, especially in neurosurgery. It is important to be able to relate preoperative, intraoperative and postoperative functional and anatomical brain imaging to investigate the use of these technologies and imaging data in relationship to patient outcomes and to improve safety. We have developed a technique to co-register landmarks chosen intraoperatively in patients brains with the MNI standard MRI brain to allow identification of Brodmann Areas of the tissue resected during epilepsy surgeries. Methods: Tissue samples were collected from 12 patients (6M, 6F; age range 2-18 years, mean 9 years) undergoing resective epilepsy surgery [hemispherectomy (1), frontal (3), temporal (5), parietal (1), temporal/occipital (1), temporal/frontal/insular (1)]. Coordinates from intraoperative tissue localization were downloaded from a Medtronics (Stealth) system and transformed into patient space using BioImage Suite(1). Tissue landmarks and patient space were then transformed to MNI standard space via linear co-registration, and the Brodmann Areas Atlas Tool in BioImage Suite was used to identify the areas that were tagged with Stealth intraoperatively. 1)Papademetris, X The international journal of medical robotics + computer assisted surgery (1478-5951)June 2009, 5 (2), 147.Results: Brodmann areas were identified for 8 of the 12 patients. The remaining four patients had abnormal brain anatomy that could not be co-registered with the MNI standard brain using a linear transformation. Due to brain deformation from surgery, the Stealth landmarks tended to be altered from the original anatomical location, where the shift was dependent on the size of the craniotomy, position of the patient, and extent and type of tissue resectedConclusions: This tissue tracking technique allows localization of tissue that is resected from epilepsy patients, and identification of the Brodmann Area for each resected region. Further processing of dissected brain tissue for pathology, gene, or protein expression can then be correlated with clinical factors and functional neuroimaging studies on the same patient. This permits investigations of patient outcome and correlation with functional outcomes.