Accurate and ergonomic method of registration for image-guided neurosurgery

There has been considerable interest in the development of frameless stereotaxy based upon scalp mounted fiducials. In practice we have experienced difficulty in relating markers to the image data sets in our series of 25 frameless cases, as well as inaccuracy due to scalp movement and the size of the markers. We have developed an alternative system for accurately and conveniently achieving surgical registration for image-guided neurosurgery based on alignment and matching of patient forehead contours. The system consists of a laser contour digitizer which is used in the operating room to acquire forehead contours, editing software for extracting contours from patient image data sets, and a contour-match algorithm for aligning the two contours and performing data set registration. The contour digitizer is tracked by a camera array which relates its position with respect to light emitting diodes placed on the head clamp. Once registered, surgical instrument can be tracked throughout the procedure. Contours can be extracted from either CT or MRI image datasets. The system has proven to be robust in the laboratory setting. Overall error of registration is 1 - 2 millimeters in routine use. Image to patient registration can therefore be achieved quite easily and accurately, without the need for fixation of external markers to the skull, or manually finding markers on the scalp and image datasets. The system is unobtrusive and imposes little additional effort on the neurosurgeon, broadening the appeal of image-guided surgery.