Visor 2.0 neuronavigation system

In order to identify the scalp site for MRI-guided rTMS of the left DLPFC as faithfully as possible, the Visor 2.0 neuronavigation system (ANT Neuro, Enschede, Netherlands) itself was used to identify the stimulation target and associated scalp site that was actually used during MRI-guided rTMS in each individual (Fig. 3). After loading each subject’s raw MRI images into the Visor software, standard neuroanatomical landmarks were first identified, including the anterior commissure, posterior commissure, inter-hemispheric plane, and extrema of the cortex, to allow definition of standard stereotaxic space. Next, the left DLPFC target site was identified using the MNI coordinate [X − 38 Y + 44 Z + 26], previously identified as optimal based on functional connectivity and clinical efficacy [14 (link)]. Finally, the most proximate point on the scalp surface to this site was localized, by identifying the voxel on the scalp surface at minimum Euclidean distance from the target MNI coordinate via manual exploration, followed by a survey of all adjacent voxels to confirm the identified voxel as most proximal to the target coordinate (Fig. 3). This voxel was then marked in the Visor 2.0 software, and the entire image volume and marker were then exported in DICOM format for comparison to the BeamF3 site in Osirix software, as below.