• Roman Rodionov, Christian Vollmar, Mark Nowell, Anna Miserocchi, Tim Wehner, Caroline Micallef, Gergely Zombori, Sebastien Ourselin, Beate Diehl, Andrew W McEvoy, and John S Duncan.
• 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.
• Epilepsy Res. 2013 Nov 1;107(1-2):91-100.

BackgroundSince 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.MethodsWe 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.ResultsThe 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.ConclusionWe 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.Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

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