Anatomical targeting in functional neurosurgery by the simultaneous use of multiple Schaltenbrand-Wahren brain atlas microseries.

This paper presents a novel approach for the use of the Atlas for Stereotaxy of the Human Brain by Schaltenbrand and Wahren [Stuttgart, Thieme, 1977] for anatomical targeting in functional neurosurgery. We propose to use simultaneously all three electronic axial, coronal and sagittal mutually coregistered Schaltenbrand-Wahren brain atlas microseries. The printed atlas microseries are digitized, extended to cover both hemispheres, contoured, labeled, organized into atlas volumes, and mutually coregistered. The electronic atlas is interactively registered with the data by using the three-dimensional Talairach proportional grid system transformation, followed up by local warping in the region of interest based on any clearly visible landmarks. The detailed targeting steps for pallidotomy, thalamotomy and subthalamotomy are formulated. The potential of this approach is to increase the accuracy of target definition, to decrease the time of the procedure by reducing the number of microelectrode tracts, and to give an extra degree of confidence to the neurosurgeon. The advantages of the approach and the limitations of the Schaltenbrand-Wahren atlas are discussed.