Ultra-High Field Magnetic Resonance Imaging for Stereotactic Neurosurgery

Stereotactic neurosurgery is a subspecialty within neurosurgery concerned with accurate targeting of brain structures. Deep brain stimulation (DBS) is a specific type of stereotaxy in which electrodes are implanted in deep brain structures. It has proven therapeutic efficacy in Parkinson’s disease and Essential Tremor, but with an expanding number of indications under evaluation including Alzheimer’s disease, depression, epilepsy, and obesity, many more Canadians with chronic health conditions may benefit. Accurate surgical targeting is crucial with millimeter deviations resulting in unwanted side effects including muscle contractions, or worse, vessel injury. Lack of adequate visualization of surgical targets with conventional lower field strengths (1.5/3 Tesla) has meant that standard-of-care surgical treatment has relied on indirect targeting using standardized landmarks to find a correspondence with a histological ``template\u27\u27 of the brain. For this reason, these procedures routinely require awake testing and microelectrode recording, which increases operating room time, patient discomfort, and risk of complications. Advances in ultra-high field (\u3e= 7 Tesla or 7T) imaging have important potential implications for targeting structures enabling better visualization as a result of its increased (sub-millimeter) spatial resolution, tissue contrast, and signal-to-noise ratio. The work in this thesis explores ways in which ultra-high field magnetic resonance imaging can be integrated into the practice of stereotactic neurosurgery. In Chapter 2, an ultra-high field MRI template is integrated into the surgical workflow to assist with planning for deep brain stimulation surgery cases. Chapter 3 describes a novel anatomical fiducial placement protocol that is developed, validated, and used prospectively to quantify the limits of template-assisted surgical planning. In Chapter 4, geometric distortions at 7T that may impede the ability to perform accurate surgical targeting are characterized in participant data, and generally noted to be away from areas of interest for stereotactic targeting. Finally, Chapter 5 discusses a number of important stereotactic targets that are directly visualized and described for the first time in vivo, paving the way for patient-specific surgical planning using ultra-high field MRI