Voxel-wise Planning Atlas for Stereotactic Neurosurgery

Introduction: Modern stereotaxy allows neurosurgeons to target brain areas using small incisions and with minimal disruption of normal brain tissue. Target points are selected based on patient pathology and treatment goal. Stereotactic plans aim to minimize traversal of normal brain parenchyma, minimize risk of vascular injury, and maximize orthogonality to the skull. These general principles are applied to most stereotactic procedures and lead to similar trajectories across patients with similar targets. Our objective was to create a 3D stereotaxy atlas from a large cohort of patients that could be used to streamline surgical planning and optimize planning algorithms.

Methods: Patients that underwent stereotactic procedures at Children’s Memorial Hermann Hospital and Texas Children’s Hospital from 2018 to 2024 were included. Stereotactic plans were generated on the ROSA and STEALTH planning stations. These plans were registered to a common template generated from the cohort’s pre-operative imaging. Spheroids were created at each point with various radiuses to create atlases with different degrees of spatial resolution. The averages were taken across all subjects to create the stereotactic atlas with the spatial information of the target point saved as its coordinate in template space and the coordinates of the entry point saved as the voxel intensity.

Results: Forty patients from Children’s Memorial Hermann Hospital and 377 patients from Texas Children’s Hospital were included in this study with a total of 2748 stereotactic trajectories targeting over 400 unique anatomical targets. The majority of the procedures consisted of stereotactic EEG electrode placement with 64 subjects having 10 or more electrodes placed and 12 subjects having 30 or more placed. Multiple atlases were made of different spheroid dilations with larger dilations resulting in more target voxels and the entry point coordinates were encoded as RGB for easier visualization.

Conclusion : A 3D voxel-wise stereotaxy atlas can be created by using a large cohort of previously created stereotaxy plans. Such atlases can be used to optimize workflows by generating preliminary trajectories and for development of future stereotaxy trajectory optimization algorithms.