Structural Imaging and Target Visualization

The explosion in neuroimaging techniques beginning in the 1970s has led to a revolution in our ability to identify, define, and visualize targets deep within the brain. These techniques have since been adopted and adapted to the neurosurgical OR, improving outcomes and making new targets amenable to intervention. They simultaneously improve consistency of targeting key structures across patients while allowing for individualization of targets and trajectories for each patient, thus compensating for individual variability as well as disease-specific structural changes. This chapter outlines the theoretical and practical principles of imaging modalities involved in target visualization. These principles are discussed with particular focus on decision making as well as the clinical drawbacks and merits of specific options and approaches. Further, we discuss the integration of these approaches into the neurosurgical workflow, beginning from operative planning and concluding with postsurgical imaging and follow-up. Finally, we engage in a limited discussion of functional neuroimaging in the context of its ability to help define and visualize structural targets in the brain.