Image-Guided Neurosurgery at Brigham and Women’s Hospital

  • Shin Nakajima
  • Ron Kikinis
  • Peter McL. Black
  • Hideki Atsumi
  • Michael E. Leventon
  • Nobuhiko Hata
  • David C. Metcalf
  • Thomas M. Moriarty
  • Eben AlexanderIII
  • Ferenc A. Jolesz


We have been conducting various forms of image-guided neurosurgery for several years. Our image-guided therapy program includes surgical planning, intraoperative guidance using preoperative images, and intraoperative guidance using real-time magnetic resonance (MR) images. In the Surgical Planning Laboratory, we produce three-dimensional (3-D) images by reconstructing image data from computed tomograms (CT), MR imaging, and MR angiograms (MRA). These images are transferred through a network to SUN workstations in the Surgical Planning Laboratory. Registration between each modality is performed using the maximization of mutual information method. After the segmentation of each anatomical structure, such as brain, tumor, ventricles, or vessels, a 3-D model is constructed and displayed using surface rendering. We can rotate, translate, change color, and make translucent each structure on the computer display. Presurgically, this 3-D model is used to evaluate the surgical risks, choose the best method of intervention, and select the most appropriate surgical approach. In the operating room, either the video registration method or a frameless stereotaxic system is used for navigation. The 3-D model is superimposed onto the surgical field using a video mixer for the video registration system. The surgical navigator displays the tip of the probe on the 3-D model and original MR images for frameless stereotaxy. The other image-guided neurosurgery project involves the open-configuration intraoperative MR imaging system. This system produces MR scans of the patient during various types of neurosurgical procedures. Two surgeons can obtain access to the patient through a 56-cm space in the 0.5-tesla superconducting magnet. They can look at frequently updated MR images during surgery. So far this system has been used for frameless stereotaxic brain biopsies, for tumor or arteriovenous malformation (AVM) resection, and for various shunting or cyst-draining procedures.

Key words

3-D reconstruction Computer-assisted neurosurgery Image-guided surgery (IGS) Intraoperative magnetic resonance image (MRI) Surgical navigator 


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Copyright information

© Springer-Verlag Tokyo 1997

Authors and Affiliations

  • Shin Nakajima
    • 1
    • 6
  • Ron Kikinis
    • 1
    • 6
  • Peter McL. Black
    • 2
    • 6
  • Hideki Atsumi
    • 1
    • 6
  • Michael E. Leventon
    • 3
  • Nobuhiko Hata
    • 1
    • 6
  • David C. Metcalf
    • 1
    • 4
  • Thomas M. Moriarty
    • 2
    • 6
  • Eben AlexanderIII
    • 2
    • 6
  • Ferenc A. Jolesz
    • 5
    • 6
  1. 1.Image-Guided Therapy Program and Surgical Planning Laboratory, Department of RadiologyBrigham and Women’s HospitalBostonUSA
  2. 2.Division of NeurosurgeryBrigham and Women’s HospitalBostonUSA
  3. 3.Artificial Intelligence LaboratoryMassachusetts Institute of TechnologyCambridgeUSA
  4. 4.Department of Computer ScienceBoston UniversityBostonUSA
  5. 5.Department of RadiologyBrigham and Women’s HospitalBostonUSA
  6. 6.Harvard Medical SchoolBostonUSA

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