Three-dimensional neuronavigation in SEEG-guided epilepsy surgery

Area of Science:

• Neurosurgery
• Medical Imaging
• Computational Neuroscience

Background:

• Precise definition of the epileptogenic zone is critical for successful epilepsy surgery, particularly in non-lesional cases.
• Stereoelectroencephalography (SEEG) aids in delineating the epileptogenic zone.
• Advanced 3D reconstruction and neuronavigation techniques are essential for complex cortical surgeries.

Purpose of the Study:

• To present a technique for 3D neuronavigation based on brain surface and SEEG electrode reconstructions.
• To evaluate the accuracy and precision of this 3D neuronavigation method for epilepsy surgery.
• To demonstrate the utility of free software (FSL and 3DSlicer) in this process.

Main Methods:

• Utilized DICOM data from pre-SEEG MRI and post-SEEG CT scans of 26 drug-resistant epilepsy patients.
• Employed FSL and 3DSlicer for post-processing of imaging data and 3D reconstruction of SEEG electrodes.
• Performed intraoperative 3D neuronavigation guided by the reconstructed models.

Main Results:

• Achieved high accuracy in 3D SEEG reconstruction (0.8 mm) and precision (1.5 mm).
• Demonstrated a mean accuracy of 2.68 mm and precision of 1.48 mm for 3D SEEG neuronavigation.
• Successfully guided 26 epilepsy surgeries using the developed 3D neuronavigation technique.

Conclusions:

• 3D neuronavigation for SEEG-guided epilepsy surgery is feasible and reliable using free, commonly available software.
• This method is effective even with navigation systems lacking a brain extraction tool.
• The technique offers a valuable approach for precise epileptogenic zone localization in epilepsy surgery.