Resection planning in extratemporal epilepsy surgery using 3D multimodality imaging and intraoperative MRI

Abstract

Surgical resection in non-lesional, extratemporal epilepsy, informed by stereoEEG recordings, is challenging. There are no clear borders of resection, and the surgeon is often operating in deep areas of the brain that are difficult to access. We present a technical note where 3D multimodality image integration in EpiNav^TM is used to build a planned resection model, based on a previous intracranial EEG evaluation. Intraoperative MRI is then used to ensure a complete resection of the planned model. As stereoEEG becomes more common in the presurgical evaluation of epilepsy, these tools will become increasingly important to facilitate targeted cortical resections.

Keywords:

• Image-guided surgery
• neuronavigation
• functional neurosurgery
• operation

Acknowledgements

We are grateful to the Wolfson Trust and the Epilepsy Society for supporting the Epilepsy Society MRI scanner. This work was supported by the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (BRC).

Disclosure statement

Mark Nowell, Gergely Zombori, Rachel Sparks and Roman Rodionov are supported by the Department of Health and Wellcome Trust through the Health Innovation Challenge Fund (HICF-T4-275, Programme Grant 97914. John Duncan has received Institutional grant support from Eisai, UCB Pharma, GSK, Janssen Cilag, Medtronic, and GE Healthcare. Andrew McEvoy has received support from UCB, Baxter, and Cyberonics. The remaining authors report no other declarations of interest concerning the materials or methods used in this study or the findings specified in this paper.

This publication presents independent research supported by the Health Innovation Challenge Fund (HICF-T4-275, Programme Grant 97914), a parallel funding partnership between the Department of Health and Wellcome Trust. The views expressed in this publication are those of the author(s) and not necessarily those of the Department of Health or Wellcome Trust.

Additional information

Funding

This publication represents in part independent research commissioned by the Health Innovation Challenge Fund (HICF-T4-275, WT097914, WT106882), a parallel funding partnership between the Wellcome Trust and the Department of Health, and the National Institute for Health Research University College London Hospitals Biomedical Research Centre (NIHR BRC UCLH/UCL High Impact Initiative). This work was undertaken at University College London Hospitals, which received a proportion of funding from the Department of Health?s NNIHR BRC funding scheme. The views expressed in this publication are those of the authors and not necessarily those of the Wellcome Trust or NIHR. John Duncan has received Institutional grant support from Eisai, UCB Pharma, GSK, Janssen Cilag, Medtronic, and GE Healthcare. Andrew McEvoy has received support from UCB, Baxter, and Cyberonics.