A guidance system for electrode placement in epilepsy cases

Xiaoyao Fan; David W. Roberts; Keith D. Paulsen

doi:10.1117/12.2549649

16 March 2020 A guidance system for electrode placement in epilepsy cases

Xiaoyao Fan, David W. Roberts, Keith D. Paulsen

Proceedings Volume 11315, Medical Imaging 2020: Image-Guided Procedures, Robotic Interventions, and Modeling; 113150O (2020) https://doi.org/10.1117/12.2549649
Event: SPIE Medical Imaging, 2020, Houston, Texas, United States

Abstract

In medically intractable epilepsy cases, subdural electrodes are often implanted for localization of epileptogenic foci. Electrode array placement is typically planned prior to surgery to ensure coverage of potential pathological tissues. Image guidance ensures accurate and effective placement of electrodes but the efficacy can be degraded by intraoperative brain shift. We have developed a guidance system to plan electrode placement interactively and execute the plan through image guidance, and compensate for brain shift due to dural opening by updating electrode positions to maintain their relative positions with respect to the cortical surface. One patient case was evaluated retrospectively to assess the performance of the guidance system. Preoperative magnetic resonance images were segmented to create a 3D model of the brain. Users selected a pre-defined electrode grid template and interactively placed it onto the segmented brain. The grid was deformed to wrap over the cortical surface based on local curvature. Intraoperative stereovision data was registered with preoperative MR to measure cortical shift, and the average shift across the exposed cortical surface was used to update electrode positions. A DICOM image stack can be created and transferred to the navigation system to create a model to represent the electrode array, and the model can be visualized on the operating microscope for intraoperative guidance. Distance change from each electrode to three landmarks on the cortical surface was quantified to assess the accuracy of electrode updating. The overall workflow time was <5 min with an overall accuracy of 0.36 mm across three landmarks.

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Xiaoyao Fan, David W. Roberts, and Keith D. Paulsen "A guidance system for electrode placement in epilepsy cases", Proc. SPIE 11315, Medical Imaging 2020: Image-Guided Procedures, Robotic Interventions, and Modeling, 113150O (16 March 2020); https://doi.org/10.1117/12.2549649

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KEYWORDS

Electrodes

Brain

Image registration

Epilepsy

Microscopes

Neuroimaging

Navigation systems

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