Three-dimensional neuronavigation in SEEG-guided epilepsy surgery

  • Krasimir MinkinEmail author
  • Kaloyan Gabrovski
  • Stanimir Sirakov
  • Marin Penkov
  • Yuri Todorov
  • Vasil Karakostov
  • Petia Dimova
Technical Note - Functional Neurosurgery - Epilepsy
Part of the following topical collections:
  1. Functional Neurosurgery – Epilepsy



Epilepsy surgery is mainly cortical surgery and the precise definition of the epileptogenic zone on the complex cortical surface is of paramount importance. Stereoelectroencephalography (SEEG) may delineate the epileptogenic zone even in cases of non-lesional epilepsy. The aim of our study was to present a technique of 3D neuronavigation based on the brain surface and SEEG electrodes reconstructions using FSL and 3DSlicer software.

Patients and methods

Our study included 26 consecutive patients operated on for drug-resistant epilepsy after SEEG exploration between January 2015 and December 2017. All patients underwent 1.5 T pre-SEEG MRI, post-SEEG CT, DICOM data post-processing using FSL and 3DSlicer, preoperative planning on 3DSlicer, and intraoperative 3D neuronavigation. Accuracy and precision of 3D SEEG reconstruction and 3D neuronavigation was assessed.


We identified 125 entry points of SEEG electrodes during 26 operations. The accuracy of 3D reconstruction was 0.8 mm (range, 0–2 mm) with a precision of 1.5 mm. The accuracy of 3D SEEG neuronavigation was 2.68 mm (range, 0–6 mm). The precision of 3D neuronavigation was 1.48 mm.


3D neuronavigation for SEEG-guided epilepsy surgery using free software for post-processing of common MRI sequences is possible and a reliable method even with navigation systems without a brain extraction tool.


Neuronavigation Three-dimensional reconstruction Cortical topography Cortical relief Eloquent cortex Epilepsy surgery 


Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the University Hospital “Saint Ivan Rilski” and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity Hospital “Saint Ivan Rilski”SofiaBulgaria
  2. 2.Department of RadiologyUniversity Hospital “Saint Ivan Rilski”SofiaBulgaria

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