An Improved Neurosurgical Planning Method for Focal Epileptic Seizure Surgery using Stereo-EEG-Based Source...

Area of Science:

• Neurosurgery
• Medical Imaging
• Epileptology

Background:

• Refractory focal epilepsy requires surgical resection of the seizure onset zone (SOZ).
• Accurate SOZ localization is crucial to minimize damage to eloquent cortex.
• Stereoencephalography (StereoEEG) aids SOZ localization by tracking epileptic signal propagation.

Purpose of the Study:

• To develop and validate a novel, automated method for SOZ localization using multimodal image processing.
• To improve the accuracy and efficiency of SOZ identification for epilepsy surgery.

Main Methods:

• Proposed a novel pipeline integrating stereo-EEG, CT, and MRI data.
• Utilized multimodal image processing and spatial transformations to create a statistical SOZ representation on a cortical surface model.

Main Results:

• Successfully identified the SOZ in both MRI-positive (80-90% within resection cavity) and MRI-negative (60-75% within resection cavity) cases.
• Demonstrated a >50% reduction in SOZ volume determination in both patient types.
• Electrophysiological input from distant electrodes contributed to accurate localization.

Conclusions:

• The proposed automated method offers a more accurate solution for SOZ localization.
• Precise localization may enable smaller resection volumes, improving seizure freedom and reducing neurological deficits.
• This approach has the potential to reduce clinical workload in epilepsy surgery planning.