Three-dimensional visualization of subdural electrodes for presurgical planning

Area of Science:

• Neurosurgery
• Medical Imaging
• Epilepsy Research

Background:

• Accurate localization of subdural electrodes for intracranial electroencephalography (iEEG) in medically refractory epilepsy is clinically challenging.
• Effective visualization is crucial for surgical planning in epilepsy treatment.

Purpose of the Study:

• To introduce a novel technique for creating accurate 3D brain models with overlaid subdural electrode visualizations.
• To enhance pre-surgical planning for epilepsy by providing precise electrode localization.

Main Methods:

• Utilized postimplantation MRI and CT imaging to generate 3D brain models.
• Created electrode models from CT imaging with intensity thresholding.
• Incorporated visualization of electrode footprints ('shadows') for improved sulcus-straddling electrode identification.
• Validated electrode model accuracy against intraoperative photography.

Main Results:

• Successfully generated realistic 3D representations of intracranial electrode positions on patient-specific MRI renderings.
• Demonstrated high accuracy of the created models when compared to intraoperative photographs.
• Confirmed visualization of interhemispherically placed electrodes.
• Found electrode 'shadows' effective for locating sulcus-straddling electrodes.

Conclusions:

• Presented an accurate and reliable method for visualizing subdural electrodes on 3D brain models.
• The developed technique provides an ideal platform for surgical planning in epilepsy cases requiring resective surgery.