Computerized Atlas-Guided Positioning of Deep Brain Stimulators: A Feasibility Study

Optimal placement of a deep brain stimulator (DBS) is an iterative procedure. A target is chosen preoperatively based on anatomical landmarks identified on MR images. This point is used as an initial position that is refined intraoperatively using both micro-electrode recordings and macrostimulation. Because the length of the procedure increases with the time it takes to adjust the DBS to its final position, a good initial position is critical. In this work we ex- plore the possibility of using an atlas and non-rigid registration algorithms to select the initial position automatically. We compare the initial DBS position obtained with this approach and the initial position selected by a neurosurgeon with the final position for eight STN (subthalamic nucleus) cases. Our results show that the automatic method leads to initial positions that are closer to the final positions than the initial positions selected manually.