Blanc SIMI 2 - Sciences de l'information, de la matière et de l'ingénierie : Sciences de l’information, simulation

Model based Computer Assisted Surgical Planning in Deep Brain Stimulation – ACouStiC

ACouStiC: Straight to the Center of the Brain

ACouStiC developed an assistance tool in a high tech and very risky discipline, Deep Brain Stimulation, used to treat severely incapacitating illnesses such as Parkinson’s disease or obsessive compulsive disorders. In more precise terms,

Model based Computer Assisted Surgical Planning, performance and assessment in Deep Brain Stimulation

ACouStiC studied, developed and validated software tools to help prepare, perform and evaluate surgical interventions. The operation involves implanting electrodes in deep brain structures to stimulate very precise anatomical structures. The results are immediate and spectacular. For example, for patients with Parkinson’s disease, shaking and rigidity of the limbs reduce or disappear completely: the patients regain an almost normal quality of life. Except that there can also be some secondary effects. For Parkinson’s disease, the target is the size of an almond in the middle of the brain, a small part of this almond having to be stimulated only. And when stimulating this area, the areas around it may also be stimulated, resulting in clinical side effects. This is why a great precision is needed. The more precise the stimulation is, the better the clinical results are. But there is no consensus about the exact target location. Tools are needed to better understand areas that give the best clinical results when stimulated.

To improve this precision and improve understanding, ACouStiC worked from different medical imaging modalities to calculate, for each patient, a 3D model of his or her brain. «We process a maximum amount of information to define the best implantation area and to determine the intervention route that will be the least dangerous for the patient». The tool also carries out a statistical process to refine the decision-making assistance from the operational history. Another objective is to shorten the operating time because the patient stays awake while their brain is being operated on. «If we can simplify the whole process, it will then benefit as many patients as possible».

Developed methods and software were evaluated retrospectively on 92 patients, on phantoms. First pre clinical evaluations are conducted in two clinical centers. The project went beyond what was originally planned. Initially focused on pre operative planning, the project studied intra and post operative stages also and provides the surgeons and neurologists with a complete solution from planning, intra operative assistance, post operative evaluation and post operative programming support.

One publication from the partners presenting some developments of the project received the 2014 Best Paper Award at the International Conference of Computer Assisted Radiology and Surgery (CARS) in Fukuoka (Japan). The whole project was awarded with the 2013 Grand Prix des trophées “Loading the Future”.

Two patents were submitted. Software are protected by Agence de Protection des Programmes (APP).

The main objective of this project is to develop an innovative strategy based on models for helping decision-making process during surgical planning in Deep Brain Stimulation (DBS) by simulating the surgical procedure. Two types of models will be made available to the surgeon: patient specific models and generic models. The project will develop methods for 1) building these models and 2) automatically computing optimal electrodes trajectories from these models taking into account possible simulated deformations occurring during surgery.

Parkinson Disease (PD) prevalence is about 1% in adults over 60 years old. High frequency Deep Brain Stimulation (DBS) has been demonstrated as an efficient minimally invasive surgical treatment for treating Parkinson or motor related diseases and recently severe neuropsychological diseases. It was originally developed in France by Pr. Benabid (Grenoble). As demonstrated in the literature, the quality of the clinical improvement, as well as the existence of motor, neuropsychological or psychiatric post operative side effects strongly depend on the location of the electrode, and therefore on the quality of the surgical planning.

We aim at developing a new approach including data and methods for increasing the accuracy and precision of DBS surgical planning when defining the electrode trajectory. To the data already used by the surgeon, we will add vessels and cortical sulci extracted from MR images, and fiber tracts computed from Diffusion Tensor MRI (DTI). To the information already used by the surgeon, we will add a histological atlas aiming at modelling anatomical knowledge and anatomo-clinical atlases aiming at modelling the knowledge related to the surgical experience. The histological atlas, we developed, has been recognized by the international community as one of the best available for DBS. The anatomo-clinical atlases will gather the locations of the electrodes computed from post operative CT images and registered to a common anatomical referential coordinate system consisted in a MR template, and the pre and post operative clinical scores. We will develop an adapted non linear image registration methods for allowing accurate submillimeter transformation of information from atlas to patient data. We will develop a method for automatic computation of the possible electrode trajectories, taken into account the rules expressed by the surgeons, the knowledge available in the atlas, and the patient specific data and information. For better accuracy and precision, we will also simulate the possible deformations of the final electrode and anatomical structures during surgery and integrate this simulation into the trajectory computation. Additionally, an important effort will be assigned on the validation of the proposed tools. We will validate the proposed deformation models with rigorous studies on realistic physical phantoms. We will validate the image registration method on retrospective clinical data sets. We will quantitatively and qualitatively validate the computation of optimal trajectories in a large population of retrospective clinical data sets available in the two clinical centers associated to this project.

The main expected output of this project will consist in a DBS planning software made available to the neurosurgical and neurological communities, as a software suite compatible with the French open source medical imaging software platforms.

This project will be able to address the issue of accurate DBS targeting from an innovative approach. It aims at putting the French research in the front of the scene concerning surgical planning in DBS, from the technological point of view.

Project coordination

Pierre JANNIN (UNIVERSITE DE RENNES I) – pierre.jannin@univ-rennes1.fr

The author of this summary is the project coordinator, who is responsible for the content of this summary. The ANR declines any responsibility as for its contents.

Partner

INRIA INRIA - Centre Lille-Nord Europe
CRICM CNRS - DELEGATION REGIONALE ILE-DE-FRANCE SECTEUR PARIS B
IRISA UNIVERSITE DE RENNES I
LSIIT UNIVERSITE DE STRASBOURG

Help of the ANR 495,192 euros
Beginning and duration of the scientific project: - 48 Months

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