A modular and flexible pipeline for intraoperative electrode reconstruction and localization in patients with brain lesions
Abstract
Intraoperative intracranial electrophysiological recordings provide unique access to human cortical dynamics but remain difficult to translate across patients due to inconsistent localization of transient surface electrodes. Unlike chronic implantations, intraoperative electrodes are placed transiently, rarely visible on imaging, and often inconsistently documented. We present an open-source imaging pipeline, ALIGNER (Advanced Localization and Imaging Guidance for Neurosurgical Electrode Recording), designed to reconstruct intraoperative surface electrode array placements and quantitatively map neural activity to individualized anatomical and pathological substrates. By enabling anatomical localization of these electrodes, this framework supports systematic analysis of spatial gradients in neural activity relative to pathological tissue. We developed a multimodal reconstruction framework integrating pre- and postoperative MRI and CT, cortical surface modeling, semi-automated pathology segmentation, intraoperative photographs or videos when available, and physics-based electrode modeling. To improve robustness in cases with distorted anatomy, artificial intelligence tools such as SynthSR were used to enable reliable cortical surface reconstruction prior to FreeSurfer processing. A monocular depth-estimation network was incorporated to constrain electrode placement in conjunction with Blender cloth-physics simulation when photographic images were available, while atlas- and…
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