CASS Epilepsy Treatment Planning System

As a module to the CASS family of computer systems, MIDCO has produced a highly advanced epilepsy treatment planning system (CASS-EPS) for epilepsy diagnostics and treatment planning. CT, MR, PET, SPECT and angiographic imaging are combined with a unique whole brain mapping system which allows accurate anatomical positioning and cross-correlation of depth electrodes, epidural buttons, and cortical subdural flap electrode positioning. EEG and EMEG data can also be integrated in this imaging environment. A specially designed temporal lobe volume determination is available as a complement to this CASS module.


Whole Brain Mapping System MRI data set showing the Talairach/Tournoux type whole brain mapping system in which the caudate nucleus and anterior commissure have been automatically located and segmented from surrounding image data.
The CASS Whole Brain Mapping System is integrated into the CASS Epilepsy Treatment Planning System for precise anatomical topography and positioning of depth electrodes, cortical epidural buttons and subdural flap electrodes. EEG and EMEG anatomical topography is readily determined in this 3-D imaging environment.

Three mapping systems based upon common reference structures about the third and fourth ventricular core of the brain are used in conjunction with internationally recognized nomenclature to create a normalized whole brain mapping system according to the Talairach/Tournoux proportional grid technique. This computerized whole brain mapping system can be used in conjunction with MR, CT, angiographic and other brain imaging techniques.

Depth Electrode Plan

3D MR imaging showing bilateral depth electrode placed in the orbital frontal regions and temporal lobes.The CASS-EPS has a unique module for 3-D depth electrode positioning. With this module, the surgeon can accurately position depth electrodes using MR or CT stereotactic techniques. When used in conjunction with the CASS Whole Brain Mapping System, the brain structures in which each depth electrode contact is positioned are automatically presented to the surgeon. This also allows for easy cross- correlation between similar cases for in-depth study. Pre-operative positioning of each electrode can be confirmed by use of the c-arm or standard X-rays and the stereotactic angiographic localizer.

Cortical Array Plan

Cortial array plan Using CASS-EPS and the CASS Whole Brain Mapping System, cortical subdural flap arrays and epidural buttons can be accurately placed over a desired area. The brain structures in which each contact is positioned are automatically presented to the surgeon. Red cursors mark the position of epidural buttons. The angiographic localizer for the stereotactic frame can be used to verify the actual position of the epidural buttons.

Multi-Modality Fusion/Overlay Image Fusion

With the use of the Multi-Modality Fusion/Overlay imaging module, images from various sources can be overlaid for comparison and data transfer. This is an example of a PET image with a hypometabolic temporal lobe overlaid on a MR image.

Temporal Lobe Volume
Temporal lobe volumes can be accurately determined from serial MR images. These volumes can be projected into 3-D stereotactic space for evaluation or surgery planning