Image-guided neurosurgical treatment of epilepsy

Surgeons removing seizure-causing brain tissue currently rely on MRI scans that show structure but not function, leaving them to guess where vital areas for language, movement, and vision lie. This matters because epilepsy surgery is a high-stakes trade-off: remove too little tissue and seizures continue; remove too much and patients lose the ability to speak, see, or move. Current MRI guidance cannot map these critical functions, nor can it simulate where to safely place recording electrodes before surgery. A team led by Professor John Duncan and Dr Sebastien Ourselin at University College London has built a system that identifies functional brain areas, neural connections, and blood vessels, then displays them in 3D. They now plan to integrate this into the MRI guidance system used in the operating room, allowing surgeons to plan electrode placement and tissue removal interactively before making the first incision. If successful, this would make epilepsy surgery more precise and safer, reducing the risk of permanent disability while improving seizure control. The same approach could eventually guide surgery for brain tumours, vascular malformations, and other conditions where preserving function is critical.