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.
Highlights
In surgical practice it is crucial for the surgeon to appreciate anatomical structures and their spatial relationships to one another in three dimensions. This is especially important in neurosurgery, where the surgeon is working in a confined space, with limited visualization and access to complex anatomy
We have demonstrated the principle that the use of 3D multimodality imaging (3DMMI) confers added value in clinical decision-making
We have developed custom-designed software for multimodality image integration, advanced 3D visualization and SEEG electrode placement planning[12,13] for the treatment of epilepsy
Summary
In surgical practice it is crucial for the surgeon to appreciate anatomical structures and their spatial relationships to one another in three dimensions. Before surgery the surgeon can rotate and alter the transparency of these models, to fully understand the 3D relationships between different structures of interest This principle is termed 3D multimodality imaging (3DMMI). The first step of SEEG implantations is to develop the strategy of the implantation, defining the areas of the brain that need to be sampled This involves integrating the clinical and non-invasive EEG date, with structural imaging, with any lesion, and functional imaging data that infer the location of the source of the epilepsy. The feasibility of generating 3DMMI models to guide implantation of IC EEG electrodes in a busy epilepsy surgery practice has previously been demonstrated[11].
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