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Stereotactic neurosurgery for movement disorders involves the accurate localization of functionally distinct nuclei deep within the brain. These surgical targets exist within anatomy appearing homogeneous on preoperative magnetic resonance images (MRIs) making direct radiographic localization impossible. We have developed a visualization-oriented searchable and expandable database of functional organization representing bilaterally the sensorimotor thalamus, pallidum, internal capsule, and subthalamic nucleus. Data were obtained through microelectrode recording and stimulation mapping routinely performed during 145 functional stereotactic procedures. Electrophysiologic data were standardized using a multi-parameter coding system and annotated to their respective MRIs at the appropriate position in patient stereotactic space. We have developed an intensity-based nonlinear registration algorithm to accommodate for normal anatomical variability that rapidly warps a patient's volumetric MRI to an MRI average brain considered representative of the patient population. The annotated functional data are subsequently transformed into the average brain coordinate system using the displacement grids generated by the algorithm. When the database is searched, clustering of like inter-patient physiologic responses within target anatomy and adjacent structures is revealed. These data may in turn be registered to a preoperative MRI using a desktop computer enabling prior to surgery interactive delineation of surgical targets.

Application of a Population Based Electrophysiological Database to the Planning and Guidance of Deep Brain Stereotactic Neurosurgery