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

摘要 该项目的首要目标是创建软件，以改善颅内 EEG用于鉴定耐药性癫痫患者是否适合神经外科手术。一百万人 在美国，有许多人患有无法通过药物控制的持续癫痫发作。当前 据估计，其中一半可以通过手术切除癫痫灶得到有效治疗。 皮质组织，但他们中的大多数不会接受手术（Engel & Wiebe，2012）。 美国有200家综合癫痫中心，经认证可提供 癫痫切除术和多模式术前评估（临床症状学， 神经心理学评估、EEG、MRI、PET和颅内或icEEG）。这个问题 评估是一种软件，用于将多种成像和评估模式整合到 术前检查，以便对神经外科手术计划有信心。ICEEG的定位 由于脑移位（脑的运动和变形）， 从术前成像到用于电极位置成像的术后CT）。 随着具有个体头部电导率模型的密集阵列EEG（dEEG）的最新进展， 电源成像可以提供癫痫发作区的非侵入性估计， 然后可以引导更集中、更有效的icEEG探测，并且可能更自信， 有限的神经外科切除。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、多模态神经图像配准、dEEG源成像， 和用户界面设计来创建Sourcer IC，这是一个软件平台， 多种形式的证据来解释icEEG措施，并提高本地化的 癫痫发作区该项目的主要创新之处在于： 神经成像数据（MRI，dwMRI，fMRI，PET）与结构MRI精确配准， DICOM格式，用于导出到神经外科医生的神经导航仪软件; 个体头部棘波和癫痫发作的无创性dEEG源定位 准备icEEG电极放置的电导率模型（作为验证，而不是 探索）;由于手术植入icEEG电极而引起的脑移位的校正， 将术后CT与术前MRI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且可用的软件中 完整的质量体系监管和验证工作流程遵循FDA指南。泽雷尔 IC将建立在耶鲁大学生物影像套件的多年经验基础上， 和技术人员通过安全的Web界面访问他们的工作流程组件， 网络数据库维护并整合所有事务，以协调计算 以及数据资源，以有效完成、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.