Computerized targeting

♦ Computerized 'virtual' targeting generally begins by identifying the patient's anterior and posterior commissures on the MRI and establishing an orthogonal 3-D Cartesian coordinate system with the mid-commissural point as zero.

♦ A standard stereotactic brain atlas is then used to identify the expected location of the selected target.

106 Placement of a DBS lead.This sagittal MRI view reveals the track of the DBS lead post-implantation (arrowed).

♦ The target may then be modified based on the images to accommodate for perceived anatomical differences between the patient and the atlas.

♦ Once the anatomical target has been selected, a safe trajectory through the brain is chosen and the 'virtual' operative plan is transferred to the 'real space' of the patient's head using a stereotactic frame that attaches to the head ring during surgery.

♦ The stereotactic coordinates that define the operative target and trajectory from the virtual plan are dialled into the frame, which then guides the implantation of electrodes.

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