Sourcerer IC: A Web-Based Integrative Multi-Modal Workflow for Epilepsy Surgical Planning

摘要 这个项目的首要目标是创建软件，以改善对颅内的使用 EEG使耐药癫痫患者有资格接受神经外科手术。一百万人 在美国，患者患有不能通过药物控制的持续性癫痫。海流 据估计，其中一半可以通过手术切除癫痫患者得到有效治疗。 他们中的大多数人不会接受手术(Engel&Wiebe，2012)。 美国有200家综合性癫痫中心获得了认证，可以提供 癫痫切除和多模式术前评估(临床符号学， 神经心理评估、EEG、MRI、PET和颅内或ICEEG)。这是一个问题 评估是用于将多种成像和评估模式集成到 术前体检以保证对神经外科计划的信心。ICEEG的定位 电极经常因为大脑的移动(大脑的运动和变形)而出现问题 从术前成像到术后CT用于电极位置成像)。 随着具有单个头部电导模型的密集阵列EEG(DEEG)的最新进展， 电源成像可以提供癫痫发作起始区的无创性估计，这 可以引导更有针对性和更有效的icEEG探测，并可能更有信心和 有限的神经外科手术。目前的SBIR研究建立在我们丰富的经验基础上 使用icEEG电极定位、多模式神经图像配准、Deeg源成像、 和用户界面设计，以创建Sourcerer IC，这是一个针对 多种证据解释ICEEG措施，提高ICEEG的本土化程度 癫痫发作起始区。该项目的主要创新之处在于：多式联运一体化 神经成像数据(MRI、DWMRI、fMRI、PET)与结构MRI精确配准 用于输出到神经外科医生的神经外科医生的神经导航软件的DICOM格式；容量 单个头部棘波和癫痫发作的无创性DeEG来源定位 ICEEG电极放置准备中的电导率模型(作为验证而不是 手术植入icEEG电极所致的脑移位的矫正 将术后CT与术前MRI进行配准；也许最重要的是， 将术前检查的所有组件集成到一个直观、可用的软件中 全面的质量体系监管和验证工作流程遵循FDA的指导方针。采购商 IC将在耶鲁大学生物成像套件多年经验的基础上，使医生 和技术人员通过安全的Web界面访问其工作流组件，以及 联网的数据库维护和集成所有事务以协调计算 以及数据资源，用于高效完成、审查和实施优化的 神经外科手术计划。

Abstract The overarching goal of this project is to create software that improves the use of intracranial EEG to qualify patients with medication-resistant epilepsy for neurosurgery. One million people in the US suffer from continual seizures that are not controlled by medication. The current estimate is that half of these could be treated effectively by surgical resection of the epileptic cortical tissue, and yet the majority of them will not receive the surgery (Engel & Wiebe, 2012). There are 200 Comprehensive Epilepsy Centers in the US that are certified to provide both the epilepsy resection and the multimodal presurgical evaluation (clinical semiology, neuropsychological assessment, EEG, MRI, PET, and intracranial or icEEG). A problem for this evaluation is the software for integrating the multiple imaging and assessment modalities in the presurgical workup to allow confidence in the neurosurgical plan. The localization of the icEEG electrodes is often problematic because of brain shift (movement and deformation of the brain from the preoperative imaging to the postoperative CT used for electrode position imaging). With recent advances in dense array EEG (dEEG) with individual head conductivity models, electrical source imaging can provide noninvasive estimates of the seizure onset zone, which could then guide more focused and effective icEEG probes, and potentially more confident and limited neurosurgical resections. The present SBIR research builds on our extensive experience with icEEG electrode localization, multimodal neuroimage registration, dEEG source imaging, and user interface design to create Sourcerer IC, a software platform optimized for bringing multiple forms of evidence to interpret icEEG measures and improve the localization of the seizure onset zone. The key innovations of this project are: the integration of multimodal neuroimaging data (MRI, dwMRI, fMRI, PET) registered precisely with structural MRI in a DICOM format for export to the neurosurgeon’s neuronavigator software; the capacity for noninvasive dEEG source localization of spikes and seizure onset with individual head conductivity models in preparation for icEEG electrode placement (as validation rather than exploration); the correction of brain shift due to surgical implanting of icEEG electrodes by registering the postoperative CT to the preoperative MRI; and perhaps most importantly, the integration of all components of the presurgical workup within an intuitive and usable software workflow with full quality system regulation and validation following FDA guidelines. Sourcerer IC will build on the many years of experience with Yale’s BioImage Suite, such that physicians and technicians access their components of the workflow through secure web interfaces, and the networked database maintains and integrates all transactions to coordinate computational as well as data resources for efficient completion, review, and implementation of an optimized neurosurgical plan.