title: Intraoperative coregistration of magnetic resonance imaging, positron emission tomography, and electrocorticographic data for neocortical lesional epilepsies may improve the localization of the epileptogenic focus: a pilot study.
abstract: OBJECTIVE
  To objectively mark out abnormal areas of magnetic resonance imaging (MRI), positron emission tomography (PET), and electrocorticography (ECoG) using neuronavigation so as to 1) enhance the accuracy of margins of the epileptogenic zone and 2) understand the relationships of all the three modalities with each other.
  
  
  METHODS
  A prospective study was conducted of 37 patients with intractable epilepsy due to lesional, neocortical pathologies from noneloquent areas. Prior to surgery, fusion and transfer of MRI and PET images onto a neuronavigation system was performed. At surgery, this was correlated to intraoperative ECoG using the electrode as referential points. An objective score was created for every electrode point that was correlated with MRI and PET abnormality at the point. The extent of surgical resection was mapped out using these data.
  
  
  RESULTS
  From a total of the data recorded from 1280 electrode points, 23.5% were located over the lesion. In addition, over the lesions, 93% of PET and 66% of ECoG points were abnormal. Over the perilesional areas, 43% of PET and 45% of ECoG points were abnormal. Using these data for surgery, both lesional and perileisonal areas were resected; 33/37 patients had good outcome (25 Engel I, 8 Engel II) (mean follow-up: 23.6 ± 3.2 months; range 18-31 months).
  
  
  CONCLUSIONS
  Multimodal imaging and ECoG using this method seems to provide a better objective localization of the epileptogenic foci.
authors: Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
authors: Sarat P
authors: SP
authors: Chandra
authors: Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
authors: C S
authors: CS
authors: Bal
authors: Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
authors: Shailesh
authors: S
authors: Jain
authors: Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
authors: Shejoy P
authors: SP
authors: Joshua
authors: Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
authors: Shailesh
authors: S
authors: Gaikwad
authors: Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
authors: Ajay
authors: A
authors: Garg
authors: Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
authors: Abuzar
authors: A
authors: Ansari
authors: Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
authors: Ashima
authors: A
authors: Nehra
authors: Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
authors: Chitra
authors: C
authors: Sarkar
authors: Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India. Electronic address: manjari2tripathi@gmail.com.
authors: Manjari
authors: M
authors: Tripathi
mesh_terms: D000293:Adolescent; D000328:Adult; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000150:complications / Q000601:surgery; D003627:Data Interpretation, Statistical; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019579:Neocortex / Q000473:pathology* / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods; D010865:Pilot Projects; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Coregistration; Electrocorticography; Intraoperative; Lesional epilepsy; Multimodal imaging; Neocortical epilepsy