Neuro-Oracle: A Trajectory-Aware Agentic RAG Framework for Interpretable Epilepsy Surgical Prognosis
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arXiv
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| Natura: | Preprint |
| Pubblicazione: |
2026
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| author | Aiersilan, Aizierjiang Koubeissi, Mohamad |
| author_facet | Aiersilan, Aizierjiang Koubeissi, Mohamad |
| contents | Predicting post-surgical seizure outcomes in pharmacoresistant epilepsy is a clinical challenge. Conventional deep-learning approaches operate on static, single-timepoint pre-operative scans, omitting longitudinal morphological changes. We propose \emph{Neuro-Oracle}, a three-stage framework that: (i) distils pre-to-post-operative MRI changes into a compact 512-dimensional trajectory vector using a 3D Siamese contrastive encoder; (ii) retrieves historically similar surgical trajectories from a population archive via nearest-neighbour search; and (iii) synthesises a natural-language prognosis grounded in the retrieved evidence using a quantized Llama-3-8B reasoning agent. Evaluations are conducted on the public EPISURG dataset ($N{=}268$ longitudinally paired cases) using five-fold stratified cross-validation. Since ground-truth seizure-freedom scores are unavailable, we utilize a clinical proxy label based on the resection type. We acknowledge that the network representations may potentially learn the anatomical features of the resection cavities (i.e., temporal versus non-temporal locations) rather than true prognostic morphometry. Our current evaluation thus serves mainly as a proof-of-concept for the trajectory-aware retrieval architecture. Trajectory-based classifiers achieve AUC values between 0.834 and 0.905, compared with 0.793 for a single-timepoint ResNet-50 baseline. The Neuro-Oracle agent (M5) matches the AUC of purely discriminative trajectory classifiers (0.867) while producing structured justifications with zero observed hallucinations under our audit protocol. A Siamese Diversity Ensemble (M6) of trajectory-space classifiers attains an AUC of 0.905 without language-model overhead. |
| format | Preprint |
| id |
arxiv_https___arxiv_org_abs_2604_14216 |
| institution | arXiv |
| publishDate | 2026 |
| record_format | arxiv |
| spellingShingle | Neuro-Oracle: A Trajectory-Aware Agentic RAG Framework for Interpretable Epilepsy Surgical Prognosis Aiersilan, Aizierjiang Koubeissi, Mohamad Multimedia Artificial Intelligence Computation and Language Computer Vision and Pattern Recognition Graphics Machine Learning Predicting post-surgical seizure outcomes in pharmacoresistant epilepsy is a clinical challenge. Conventional deep-learning approaches operate on static, single-timepoint pre-operative scans, omitting longitudinal morphological changes. We propose \emph{Neuro-Oracle}, a three-stage framework that: (i) distils pre-to-post-operative MRI changes into a compact 512-dimensional trajectory vector using a 3D Siamese contrastive encoder; (ii) retrieves historically similar surgical trajectories from a population archive via nearest-neighbour search; and (iii) synthesises a natural-language prognosis grounded in the retrieved evidence using a quantized Llama-3-8B reasoning agent. Evaluations are conducted on the public EPISURG dataset ($N{=}268$ longitudinally paired cases) using five-fold stratified cross-validation. Since ground-truth seizure-freedom scores are unavailable, we utilize a clinical proxy label based on the resection type. We acknowledge that the network representations may potentially learn the anatomical features of the resection cavities (i.e., temporal versus non-temporal locations) rather than true prognostic morphometry. Our current evaluation thus serves mainly as a proof-of-concept for the trajectory-aware retrieval architecture. Trajectory-based classifiers achieve AUC values between 0.834 and 0.905, compared with 0.793 for a single-timepoint ResNet-50 baseline. The Neuro-Oracle agent (M5) matches the AUC of purely discriminative trajectory classifiers (0.867) while producing structured justifications with zero observed hallucinations under our audit protocol. A Siamese Diversity Ensemble (M6) of trajectory-space classifiers attains an AUC of 0.905 without language-model overhead. |
| title | Neuro-Oracle: A Trajectory-Aware Agentic RAG Framework for Interpretable Epilepsy Surgical Prognosis |
| topic | Multimedia Artificial Intelligence Computation and Language Computer Vision and Pattern Recognition Graphics Machine Learning |
| url | https://arxiv.org/abs/2604.14216 |