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Electrode localization for planning surgical resection of the epileptogenic zone in pediatric epilepsy

Abstract

Purpose

   In planning for a potentially curative resection of the epileptogenic zone in patients with pediatric epilepsy, invasive monitoring with intracranial EEG is often used to localize the seizure onset zone and eloquent cortex. A precise understanding of the location of subdural strip and grid electrodes on the brain surface, and of depth electrodes in the brain in relationship to eloquent areas is expected to facilitate pre-surgical planning.

Methods

   We developed a novel algorithm for the alignment of intracranial electrodes, extracted from post-operative CT, with pre-operative MRI. Our goal was to develop a method of achieving highly accurate localization of subdural and depth electrodes, in order to facilitate surgical planning. Specifically, we created a patient-specific 3D geometric model of the cortical surface from automatic segmentation of a pre-operative MRI, automatically segmented electrodes from post-operative CT, and projected each set of electrodes onto the brain surface after alignment of the CT to the MRI. Also, we produced critical visualization of anatomical landmarks, e.g., vasculature, gyri, sulci, lesions, or eloquent cortical areas, which enables the epilepsy surgery team to accurately estimate the distance between the electrodes and the anatomical landmarks, which might help for better assessment of risks and benefits of surgical resection.

Results

   Electrode localization accuracy was measured using knowledge of the position of placement from 2D intra-operative photographs in ten consecutive subjects who underwent intracranial EEG for pediatric epilepsy. Average spatial accuracy of localization was \(1.31\pm 0.69 \text{ mm }\) for all 385 visible electrodes in the photos.

Conclusions

   In comparison with previously reported approaches, our algorithm is able to achieve more accurate alignment of strip and grid electrodes with minimal user input. Unlike manual alignment procedures, our algorithm achieves excellent alignment without time-consuming and difficult judgements from an operator.

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Notes

  1. 1.

    This software will be available online (http://crl.med.harvard.edu/software/STAPLE/).

  2. 2.

    The currently distributed software is available from http://www.crl.med.harvard.edu/software.

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Acknowledgments

This research was supported in part by NIH grants R01 RR021885, R01 EB008015, R03 EB008680, R01 LM010033, and R01 EB013248.

Conflict of Interest

Vahid Taimouri, Alireza Akhondi-Asl, Xavier Tomas-Fernandez, Jurriaan M. Peters, Sanjay P. Prabhu, Annapurna Poduri, Masanori Takeoka, Tobias Loddenkemper, Ann Marie R. Bergin, Chellamani Harini, Joseph R. Madsen, and Simon K. Warfield declare that they have no conflict of interest.

Ethical Standards Statement All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Correspondence to Vahid Taimouri.

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Taimouri, V., Akhondi-Asl, A., Tomas-Fernandez, X. et al. Electrode localization for planning surgical resection of the epileptogenic zone in pediatric epilepsy. Int J CARS 9, 91–105 (2014). https://doi.org/10.1007/s11548-013-0915-6

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Keywords

  • Pediatric epilepsy
  • Intracranial EEG
  • Electrode localization
  • Epilepsy surgery planning