Potential Efficacy of Multimodal Mixed Reality in Epilepsy Surgery

Mixed reality (MR) technology, which can fuse things in real and virtual space in real time, has been used mainly for simulation in neurosurgical training.

To develop MR technology into multimodal MR for intraoperative guidance during epilepsy surgery.

A 33-yr-old male patient suffered from intractable general tonic seizures due to left temporal meningoencephalocele. Preoperative scalp electroencephalograms localized interictal epileptic activity on the left temporal lobe. Iomazenil single photon emission tomography revealed temporal lobe lateralization. Magnetic resonance imaging (MRI) demonstrated left basal temporal meningoencephalocele extending into the pterygopalatine fossa through a bone defect at the base of the greater sphenoid wing. A 3-dimensional model was created for MR based on multimodal data including computed tomography, MRI tractography, and digital subtraction angiography, which enabled 3-dimensional visualization of abnormal subcortical fiber connections between the meningoencephalocele and the epileptic focus.

By using intraoperative multimodal MR, we were able to safely remove the meningoencephalocele and perform epileptic focus resection. The patient was seizure-free postoperatively, and no adverse effects were noted.

Intraoperative multimodal MR was a feasible and effective technique, and it can be applied for a wide range of epilepsy surgeries.