A Pipeline for 3D Multimodality Image Integration and Computer-assisted Planning in Epilepsy Surgery

Abstract

Epilepsy surgery is challenging and the use of 3D multimodality image integration (3DMMI) to aid presurgical planning is well-established. Multimodality image integration can be technically demanding, and is underutilised in clinical practice. We have developed a single software platform for image integration, 3D visualization and surgical planning. Here, our pipeline is described in step-by-step fashion, starting with image acquisition, proceeding through image co-registration, manual segmentation, brain and vessel extraction, 3D visualization and manual planning of stereoEEG (SEEG) implantations. With dissemination of the software this pipeline can be reproduced in other centres, allowing other groups to benefit from 3DMMI. We also describe the use of an automated, multi-trajectory planner to generate stereoEEG implantation plans. Preliminary studies suggest this is a rapid, safe and efficacious adjunct for planning SEEG implantations. Finally, a simple solution for the export of plans and models to commercial neuronavigation systems for implementation of plans in the operating theater is described. This software is a valuable tool that can support clinical decision making throughout the epilepsy surgery pathway.

Getting the best outcomes from epilepsy surgery

“…Computer-assisted planning of electrode insertion and resection planning promise to simplify the epilepsy surgery pathway (Fig 2). 42,43 Place and Process of Intracranial EEG Intracranial EEG recordings are performed to: (1) localize the site of ictal onset when the hypotheses for location of the EZ are reasonably limited, (2) define the extent of the EZ when a tailored resection is required, and (3) map essential cortical functions adjacent to contemplated areas of resection.…”

Automated trajectory planning for laser interstitial thermal therapy in mesial temporal lobe epilepsy

“…CAP was first introduced to neurosurgery during the 1980s as a means of calculating frame‐based coordinates during stereotactic brain biopsies . Advances have included the addition of multimodal imaging, three‐dimensional (3D) model generation, pathology segmentation atlas, and whole‐brain parcellation integration . The most recent advances in CAP has been in automated trajectory planning for deep brain stimulation and SEEG procedures.…”

“…| 819 addition of multimodal imaging, 29,30 three-dimensional (3D) model generation, 31 pathology segmentation atlas, and whole-brain parcellation integration. 21 The most recent advances in CAP has been in automated trajectory planning for deep brain stimulation and SEEG procedures.…”

Accuracy of intracranial electrode placement for stereoelectroencephalography: A systematic review and meta‐analysis

“…Before SEEG electrode insertion, trajectories are carefully planned with prior knowledge of the critical neurovascular structures . Computer‐aided planning has been employed in this regard to determine the safest trajectories that maximize gray matter sampling while ensuring a safe distance from vasculature . Understanding the accuracy of the implantation method is necessary to incorporate a safe threshold away from blood vessels during trajectory planning.…”

“…7,8 Computer-aided planning has been employed in this regard to determine the safest trajectories that maximize gray matter sampling while ensuring a safe distance from vasculature. 9,10 Understanding the accuracy of the implantation method is necessary to incorporate a safe threshold away from blood vessels during trajectory planning. Cardinale et al, following a prospective analysis of 500 patients in which 6,496 electrodes were implanted, calculated a safe distance of 2.88 mm based on the mean entry point error (0.86 mm) with the addition of three standard deviations (SD; 3 9 0.54 mm) and the probe radius (0.4 mm).…”