title: Digital photography and 3D MRI-based multimodal imaging for individualized planning of resective neocortical epilepsy surgery.
abstract: OBJECTIVE
  Invasive presurgical work up of pharmacoresistant epilepsies presumes integration of multiple diagnostic modalities into a comprehensive picture of seizure onset and eloquent brain areas. During resection, reliable transfer of evaluation results to the patient's individual anatomy must be made. We investigated the value of digital photography-based grid localization in combination with preoperative three-dimensional (3D) magnetic resonance imaging (MRI) for clinical routine.
  
  
  METHODS
  Digital photographs of the exposed cortex were taken before and after grid placement. Location of electrode contacts on the cortex was identified and schematically indicated on native cortex prints. Accordingly, transfer of contact positions to a 3D MRI brain-surface rendering was carried out manually by using the rendering software. Results of the electrophysiologic evaluation were transferred to either electrode contact reproduction and co-registered with imaging-based techniques such as single-photon emission computed tomography (SPECT), positron emission tomography (PET), and functional MRI (fMRI).
  
  
  RESULTS
  Digital photography allows precise and highly realistic documentation of electrode contact positions on the individual neocortical surface. Lesions underneath grids can be highlighted by semitransparent MRI surface rendering, and lobar boundaries can be identified. Because of integrating electrode contact positions into the postprocessed 3D MRI data set, imaging-based techniques can be codisplayed with the results of the electrophysiologic evaluation. Comparison with CT/MRI co-registration showed good accuracy of the method. However, grids not sewn to the dura at implantation can become subject to significant displacement.
  
  
  CONCLUSIONS
  Digital photography in combination with preimplantation 3D MRI allows the generation of reliable tailored resection plans in neocortical epilepsy surgery. The method enhances surgical safety and confidence.
authors.affiliation: Department of Epileptology, University of Bonn, Bonn, Germany. j.wellmer@gmx.de
authors.forename: Jörg
authors.initials: J
authors.lastname: Wellmer
authors.forename: Joachim
authors.initials: J
authors.lastname: von Oertzen
authors.forename: Carlo
authors.initials: C
authors.lastname: Schaller
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
authors.forename: Roy
authors.initials: R
authors.lastname: König
authors.forename: Guido
authors.initials: G
authors.lastname: Widman
authors.forename: Dirk
authors.initials: D
authors.lastname: Van Roost
authors.forename: Christian E
authors.initials: CE
authors.lastname: Elger
mesh_terms: D000293:Adolescent; D000328:Adult; D001931:Brain Mapping; D002648:Child; D004567:Electrodes, Implanted; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019579:Neocortex / Q000503:physiopathology / Q000601:surgery*; D010347:Patient Care Planning; D010781:Photography; D012680:Sensitivity and Specificity