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Published in:
01-10-2015 | Original Article
Improving recorded volume in mesial temporal lobe by optimizing stereotactic intracranial electrode implantation planning
Published in: International Journal of Computer Assisted Radiology and Surgery | Issue 10/2015
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Abstract
Purpose
Intracranial electrodes are sometimes implanted in patients with refractory epilepsy to identify epileptic foci and propagation. Maximal recording of EEG activity from regions suspected of seizure generation is paramount. However, the location of individual contacts cannot be considered with current manual planning approaches. We propose and validate a procedure for optimizing intracranial electrode implantation planning that maximizes the recording volume, while constraining trajectories to safe paths.
Methods
Retrospective data from 20 patients with epilepsy that had electrodes implanted in the mesial temporal lobes were studied. Clinical imaging data (CT/A and T1w MRI) were automatically segmented to obtain targets and structures to avoid. These data were used as input to the optimization procedure. Each electrode was modeled to assess risk, while individual contacts were modeled to estimate their recording capability. Ordered lists of trajectories per target were obtained. Global optimization generated the best set of electrodes. The procedure was integrated into a neuronavigation system.
Results
Trajectories planned automatically covered statistically significant larger target volumes than manual plans \(({p}<0.001)\). Median volume coverage was \(419\,\hbox { mm}^{3}\) for automatic plans versus \(23\,\hbox { mm}^{3}\) for manual plans. Furthermore, automatic plans remained at statistically significant safer distance to vessels \(({p}<0.05)\) and sulci \(({p}<0.001)\). Surgeon’s scores of the optimized electrode sets indicated that 95 % of the automatic trajectories would be likely considered for use in a clinical setting.
Conclusions
This study suggests that automatic electrode planning for epilepsy provides safe trajectories and increases the amount of information obtained from the intracranial investigation.