Authors :
Presenting Author: Muhammad Usman Khalid, MD – University of Kentucky
Subhan Ahmed Khan, MD – Westchester Medical Center Health Network
Sarah H. Thomas, MD – University of Kentucky
Tripp Hines, MD – Florence Neurosurgery & Spine at McLeod Health
Farhan Mirza, MD, FAANS – University of Kentucky
Rationale:
Stereo-electroencephalography (SEEG) is increasingly central to the surgical management of drug-resistant epilepsy, offering unparalleled precision in localizing epileptogenic foci. However, the absence of a standardized post-processing workflow can impede the quality of anatomical interpretation and hinder interdisciplinary collaboration.
To develop a robust, standardized post-processing protocol for SEEG that enhances anatomical accuracy, supports multidisciplinary decision-making, and maintains clinical efficiency.
Methods:
From November 2020 to May 2025, 49 patients underwent SEEG at our NAEC Level 4 epilepsy center. Post-processing was performed using Brainlab software, with protocol refinement driven by collaborative feedback from neurosurgery, neurology, neuroradiology, and research personnel.
Results:
Two imaging datasets are essential for this protocol: a preoperative 3T T1-weighted MRI (≤2 mm slice thickness, >150 slices) and a post-implantation CT acquired using the ROSA protocol (0.6 mm slice thickness). These are co-registered using the Image Fusion tool, after which anatomical structures—typically the cerebrum, ventricles, amygdala, and hippocampus—are rendered via the Object Management module. Electrode localization is performed in the Lead Localization tool using the CT bone window. Electrodes, standardized institutionally (10, 15, or 18 contacts; 0.88 mm × 2 mm; 1.5 mm spacing), are aligned in the trajectory view and cross-verified with preoperative planning. Custom electrode formats can be saved to streamline future workflows. Each contact is anatomically labeled on the MRI (Figure 1), visualized in 3D (Figure 2), and cataloged in structured spreadsheets for clinical and research utility. Mapping complexity varies: < 8 temporal electrodes require ~2 hours; complex, bilateral cases ( >14 electrodes across multiple lobes) with distorted anatomy may take 5–6 hours. Among 24 patients, 19 underwent bilateral implantation, averaging 12 electrodes per patient.
Conclusions:
This standardized post-processing protocol enables precise SEEG electrode localization, facilitates consistent anatomical correlation, and enhances team-based care. Its integration into routine workflow supports innovation, precision, and multidisciplinary collaboration in epilepsy surgery.
Funding: No funding was received as part of this project.