Cerebral vasculature post-operative analysis : medical images processing tools in stereotactic epileptic surgeries (SEEG)

Epilepsy is one of the most common serious brain conditions, affecting over 70 million people worldwide. Epilepsy was defined as a disorder of the brain characterised by an enduring predisposition to generate epileptic seizures due to abnormal excessive or synchronous neuronal activity in the brain. For most people with epilepsy, anti-seizure medications are the main treatment modality, however, the current drugs are effective in only about 66% of individuals. For drug-resistant epilepsy patients alternative non-pharmacological treatments including surgery should be considered. If surgical treatment is proposed, localisation of the site of seizure onset or critical point in a network, is necessary by using invasive EEG recordings with depth electrodes placed stereotactically within the brain tissue. The methodology of implantation and definition of their anatomical localisation is the so-called stereoelectroencephalography (SEEG). This project aims to focus on this type of surgical intervention. In this study, a comparison protocol of Digital Subtraction Angiography reconstruction methodologies (image modality for brain vasculature) will be carried out, evaluating a first method based on the FSL program and a second method based on the combination of the intensities of the images. Subsequently, based on the choice of the best DSA reconstruction, a pilot study will be carried out with patients at the Hospital del Mar in Barcelona to create Tools to assist surgical planning, both pre-operatively and inter-operatively. Said applications are the detection of the Bone and the Dura mater in an automatic way and the creation of a clinical study environment for the analysis of the planned trajectories in SEEG surgeries with respect to the cerebral vasculature. The results of this study choose the Intensities Method as the DSA reconstruction that achieves greater preservation of the cerebral vasculature and obtains a success rate in the detection of bone and dura of more than 80% in both cases. Finally, it is also possible to establish a clinical environment in which the vessels that are less than 2mm from the electrodes are detected and, therefore, can suppose a risk to the patient. In conclusion, the objectives of the project are achieved and some of these functionalities could be incorporated as useful tools in the SEEG surgical planning protocol of Hospital del MarObjectius de Desenvolupament Sostenible::3 - Salut i BenestarObjectius de Desenvolupament Sostenible::9 - Indústria, Innovació i Infraestructur