Co-registration of intra-operative brain surface photographs and pre-operative MR images.

Purpose: Brain shift, the change in configuration of the brain after opening the dura mater, is a significant problem for neuronavigation. Brain structures at intra-operative deformed positions must be matched with corresponding structures in the pre-operative 3D planning data. A method to co-register the cortical surface from intra-operative microscope images with pre-operative MRI-segmented data was developed and tested.

Methods: Automated classification of sulci on MRI-extracted cortical surfaces was tested by comparison with user guided marking of prominent sulci on an intra-operative photography. A variational registration method with a fidelity energy for 3D deformations of the cortical surface in conjunction with a higher-order, linear elastic prior energy was used for the actual registration. The minimization of this energy was performed with a regularized gradient descent scheme using finite elements for spatial discretization. The sulcal classification method was tested on eight different clinical MRI data sets by comparison of the deformed MRI scans with intra-operative photographs of the brain surface.

Results: User intervention was required for marking sulci on the photographs demonstrating the potential for incorporating an automatic classifier. The actual registration was validated first on an artificial testbed. The complete algorithm for the co-registration of actual clinical MRI data was successful for eight different patients.

Conclusions: Pre-operative MRI scans can be registered to intra-operative brain surface photographs using a surface-to-surface registration method. This co-registration method has potential applications in neurosurgery, particularly during functional procedures.