Novel multimodality imaging in the planning and surgical treatment of epilepsy

Over 50 million people worldwide are affected by epilepsy and in one third of these the condition is poorly controlled by medication. In these patients epilepsy surgery offers potentially curative treatment. The presurgical evaluation and surgical management of epilepsy is complex. Patients typically undergo a range of imaging modalities, and may also require intracranial EEG (ic-EEG) evaluation. Cortical resections are informed by these investigations, with the aim of removing the epileptogenic zone (EZ) without causing any functional deficits. I have investigated the use of 3D multimodality image integration (3DMMI) and it's relevance in epilepsy surgery in adults. I have supported the use of 3DMMI in our busy epilepsy surgery unit, and demonstrated that disclosure of models changes and informs clinical decision making during presurgical evaluation and surgical planning. EpiNav(TM) is custom-designed software for use in epilepsy surgery, representing an image-guided solution to address the complexities of the pipeline. I have incorporated this software into our clinical workflow and demonstrated the potential benefits of computer-assistance in planning depth electrode implantations. 3DMMI and EpiNav have been crucial in the development of the stereoEEG (SEEG) service in our unit. I describe the implementation of frameless SEEG, which forms part of our simplified, image guided pipeline for epilepsy surgery. Finally, I have gained experience in the generation of optic radiation tractography using constrained spherical deconvolution techniques, which are increasingly used in clinical practice. In a pilot study I demonstrate an association between language lateralisation determined by functional MRI and asymmetry in the position of the anterior bundle of the optic radiation in patients with epilepsy.