Feasibility of multimodal 3D neuroimaging to guide implantation of intracranial EEG electrodes

Highlights • Developed pipeline for multimodal image integration to guide epilepsy surgery. • Reported the key principles of the pipeline and its detailed description. • Demonstrated feasibility of the developed pipeline for multimodal image integration. • Illustrated potential benefits of intraoperative use of the pipeline.
Summary Background Since intracranial electrode implantation has limited spatial sampling and carries significant risk, placement has to be effective and efficient. Structural and functional imaging of several different modalities contributes to localising the seizure onset zone (SoZ) and eloquent cortex. There is a need to summarise and present this information throughout the pre/intra/post-surgical course. Methods We developed and implemented a multimodal 3D neuroimaging (M3N) pipeline to guide implantation of intracranial EEG (icEEG) electrodes. We report the implementation of the pipeline for operative planning and a description of its use in clinical decision-making. Results The results of intraoperative application of the M3N pipeline demonstrated clinical benefits in all 15 implantation surgeries assessed. The M3N software was used to simulate placement of intracranial electrodes in 2 cases. The key benefits of using the M3N pipeline are illustrated in 3 representative case reports. Conclusion We have demonstrated feasibility of the developed intraoperative M3N pipeline which serves as a prototype for clinical implementation. Further validity studies with larger sample groups are required to determine the utility of M3N in routine surgical practice