Multimodal Image Integration for Epilepsy Presurgical Evaluation: A Clinical Workflow.

Area of Science:

• Neurology
• Neurosurgery
• Medical Imaging

Background:

• Medically intractable focal epilepsies require precise presurgical evaluation to identify the epileptogenic zone (EZ).
• Multimodal Image Integration (MMII) offers a comprehensive approach to combine various diagnostic data for EZ delineation.
• Previous studies highlight the potential of MMII, but detailed methodology and clinical utility require further elucidation.

Purpose of the Study:

• To detail the methodology of Multimodal Image Integration (MMII).
• To provide an overview of MMII's utility in presurgical evaluation at Cleveland Clinic Epilepsy Center (2014-2018).
• To illustrate the application of MMII through case examples and assess its impact on surgical outcomes.

Main Methods:

• MMII performed using the Curry platform, integrating MRI, PET, SPECT, and MEG.
• Trajectory planning for intracranial EEG (iEEG), including stereo-EEG (SEEG), and surgical resection planning were incorporated.
• CT co-registration used to identify electrode locations in patients undergoing iEEG implantation.

Main Results:

• 467 patients underwent MMII; 425 had iEEG implantation, and 351 proceeded to surgery.
• 50% of 269 patients with 1-year follow-up remained seizure-free post-surgery.
• Common histopathology included focal cortical dysplasia; MMII aided in re-evaluating surgical failures.

Conclusions:

• MMII is crucial for enhancing SEEG electrode trajectory planning and interpreting complex data.
• The integration of diverse imaging modalities in MMII aids in understanding anatomo-functional-electro-clinical correlations.
• MMII significantly contributes to the successful presurgical evaluation and treatment of medically intractable focal epilepsies.