Intersurgeon Variability in the Selection of Anterior and Posterior Commissures and Its Potential Effects on Target Localization
Open Access
- 13 February 2008
- journal article
- research article
- Published by S. Karger AG in Stereotactic and Functional Neurosurgery
- Vol. 86 (2), 113-119
- https://doi.org/10.1159/000116215
Abstract
Background: This study reports the intersurgeon variability in manual selection of the anterior and posterior commissures (AC and PC). The study also investigates the effect of this variability on the localization of targets like the subthalamic nucleus, ventralis intermedius nucleus and globus pallidus internus. The additional effect of variation in the selection of the mid-plane on target localization is also evaluated. Methods: 43 neurosurgeons (38 attendings, 5 residents/ fellows) were asked to select the AC and the PC points (as routinely used for stereotactic neurosurgical planning) on two MRI scans. The corresponding mid-commissural points (MCPs) and target coordinates were calculated. Results: The collected data show that the MCP is more reliable than either the AC or the PC points. These data also show that, even for experienced neurosurgeons, variations in selecting the AC and the PC point result in substantial variations at the target points: 1.15 ± 0.89 mm, 1.45 ± 1.25 mm, 1.21 ± 0.83 for the subthalamic nucleus, ventralis intermedius nucleus, and globus pallidus internus, respectively, for the first MRI volumeand 1.08 ± 1.37 mm, 1.35 ± 1.71 mm, 1.12 ± 1.17 mm for the same structures for the second volume. These variations are larger when residents/fellows are included in the data set. Conclusions: The data collected in this study highlight the difficulty in establishing a common reference system that can be used to communicate target location across sites. It indicates the need for the development and evaluation of alternative normalization methods that would permit specifying targets directly in image coordinates or the development of improved imaging techniques that would permit direct targeting.Keywords
This publication has 5 references indexed in Scilit:
- Automated selection of anterior and posterior commissures based on a deformable atlas and its evaluation based on manual selections by neurosurgeonsPublished by SPIE-Intl Soc Optical Eng ,2007
- Computer-aided placement of deep brain stimulators: from planningto intraoperative guidanceIEEE Transactions on Medical Imaging, 2005
- Thalamic Deep Brain Stimulation for Essential Tremor: Relation of Lead Location to OutcomeNeurosurgery, 2004
- Placement of Deep Brain Stimulators into the Subthalamic Nucleus or Globus pallidus internus: Technical ApproachStereotactic and Functional Neurosurgery, 2002
- Fully automatic identification of AC and PC landmarks on brain MRI using scene analysisIEEE Transactions on Medical Imaging, 1997