title: Feasibility of multimodal 3D neuroimaging to guide implantation of intracranial EEG electrodes.
abstract: BACKGROUND
  Since intracranial electrode implantation has limited spatial sampling and carries significant risk, placement has to be effective and efficient. Structural and functional imaging of several different modalities contributes to localising the seizure onset zone (SoZ) and eloquent cortex. There is a need to summarise and present this information throughout the pre/intra/post-surgical course.
  
  
  METHODS
  We developed and implemented a multimodal 3D neuroimaging (M3N) pipeline to guide implantation of intracranial EEG (icEEG) electrodes. We report the implementation of the pipeline for operative planning and a description of its use in clinical decision-making.
  
  
  RESULTS
  The results of intraoperative application of the M3N pipeline demonstrated clinical benefits in all 15 implantation surgeries assessed. The M3N software was used to simulate placement of intracranial electrodes in 2 cases. The key benefits of using the M3N pipeline are illustrated in 3 representative case reports.
  
  
  CONCLUSIONS
  We have demonstrated feasibility of the developed intraoperative M3N pipeline which serves as a prototype for clinical implementation. Further validity studies with larger sample groups are required to determine the utility of M3N in routine surgical practice.
authors.affiliation: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK; Epilepsy Society, MRI Unit, Chalfont St Peter, UK. Electronic address: r.rodionov@ucl.ac.uk.
authors.forename: Roman
authors.initials: R
authors.lastname: Rodionov
authors.forename: Christian
authors.initials: C
authors.lastname: Vollmar
authors.forename: Mark
authors.initials: M
authors.lastname: Nowell
authors.forename: Anna
authors.initials: A
authors.lastname: Miserocchi
authors.forename: Tim
authors.initials: T
authors.lastname: Wehner
authors.forename: Caroline
authors.initials: C
authors.lastname: Micallef
authors.forename: Gergely
authors.initials: G
authors.lastname: Zombori
authors.forename: Sebastien
authors.initials: S
authors.lastname: Ourselin
authors.forename: Beate
authors.initials: B
authors.lastname: Diehl
authors.forename: Andrew W
authors.initials: AW
authors.lastname: McEvoy
authors.forename: John S
authors.initials: JS
authors.lastname: Duncan
mesh_terms: D000328:Adult; D001921:Brain / Q000503:physiopathology / Q000601:surgery*; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D059906:Neuroimaging / Q000379:methods*; D038361:Neuronavigation / Q000379:methods*; D012640:Seizures / Q000503:physiopathology / Q000601:surgery*
keywords: Epilepsy; Multimodal; Neuroimaging; Surgery
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