**Review of Printed and Electronic Stereotactic Atlases of the Human Brain**

Eduardo Joaquim Lopes Alho1,2, Lea Grinberg2, Helmut Heinsen1 and Erich Talamoni Fonoff1 *1Julius-Maximilian University of Würzburg 2University of São Paulo 1Germany 2Brazil* 

### **1. Introduction**

144 Neuroimaging for Clinicians – Combining Research and Practice

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The scientific developments of the latter half of the 19th century and the beginning of the 20th century supplied comprehensive data and insight on brain structure and function. Knowledge on structure and function provided strategies and tools for the management of previously lethal or highly incapacitating diseases, e.g. Parkinson's disease (PD) and tremor. A major challenge for neurosurgery was the endeavor to reach some deep and hitherto hidden regions inside the brain without damaging the surrounding tissue, since most of these small regions are vital and not directly visible *in situ*. Using the Cartesian coordinate system based on cranial landmarks, Victor Horsley and Robert Clarke introduced in 1908 a new apparatus that allowed them to accurately target subcortical nuclei of monkeys (Horsley & Clarke, 1908) with quasi-mathematical precision. A modified version of this device was adopted by Spiegel and Wycsis (1947) for human intracerebral interventions. Nevertheless, the space in which these mechanical devices were navigating still remained obscure and perilous. Almost four decades later, the parallel progress of neuroimaging shed light into the hitherto hidden structures and regions of the human brain. However, in order to find out appropriate pathways to specific functional units within clinically relevant targets the necessity of detailed brain maps was mandatory. Even with the great advance in neuroimaging in the last twenty to thirty years, it is still not possible to unequivocally delineate closely related subcortical structures by means of high-resolution computed tomography (CT) or in magnetic resonance image (MRI) (Coffey, 2009). For this reason, brain atlases derived from appropriate histological, histochemical, or immunohistochemical techniques on post-mortem human brain tissue continue to represent an important tool for functional neurosurgeons and brain researchers. To supplement the post-mortem anatomic maps, electrophysiologic in vivo recording of neuronal activity was added to neurosurgeries. This technique is intended to be an ancillary method to assist neurosurgeons in verifying their targets. In this chapter we will summarize and critically review the merits and the shortcomings of the most frequently consulted atlases. Some ideas on scope, form, and presentation of future atlases will be forwarded.

Review of Printed and Electronic Stereotactic Atlases of the Human Brain 147

standard reference system. The second part was a textbook and revised atlas updated from

*Main lines for spatial orientation are the mediosagittal Cp-Po line that connects the posterior commissure (Cp) with the bulbopontine sulcus. The h 0, a horizontal line (perpendicular to the Cp-Po-line) which crosses the Cp-Po-line at the level of the posterior commissure. The h1 line emerges in an acute angle at the crossing point of the Ch and the Cp and runs in a rostral direction. Cran.1 and cran.2 can be considered as ancillary lines. Cran.1 is perpendicular to h1 and forms an acute angle of 4° (-i) with the CP-PO-line, cran.2 like cran.1 leaves the Cp-Po-*

Fig. 1. First intracerebral reference system proposed by Spiegel & Wycsis in 1952.

**2.2 Atlas d'anatomie stéréotaxique: Repérage radiologique indirect des noyaux gris centraux des regions mésencéphalo-sous-optique et hypothalamique de l'homme** 

The most important contribution of this publication is the use of AC and PC as reliable intracerebral stereotactic markers and their stable relationship to deep brain structures. From this work, came the concept of Talairach's space. The Talairach's space is a coordinate system based on AC and PC as pivotal landmarks. Using the distance between them and the orthogonal plans erected, it is possible to compare the location of brain structures in two different brains, independent from individual differences. Because of the individual variations in the three dimensions of human brains, the distances measured in millimeters are applicable only to one individual. This becomes increasingly true with greater distance from the basal lines. Talairach concluded that dimensions given in millimeters can apply only in a general population to the gray central nuclei, whose dimensional variations remain moderate. For this reason they presented later the three-dimensional proportional grid

the first version. This atlas is currently out of print (Coffey, 2009).

*line with an inclination of 4°, however, posterior to the Cp-Po-line (+i).* 

**(Talairach et al., 1957)** 

system ( Talairach & Tournoux, 1988).
