Aims: For the 30% of people with focal epilepsy who are medically refractory, neurosurgery is a potential treatment option. However, identifying suitable candidates and localizing the epileptogenic zone remain significant challenges. We introduce and evaluate the clinical utility of three advanced neuroimaging techniques developed at established epilepsy surgery centers in the pre-surgical assessment at the recently designated District Epilepsy Center, Kingston Health Sciences Center (KHSC).Methods: Patients in the pre-surgical pathway were discussed in multidisciplinary team (MDT) meetings (n=21). Patients who had already undergone resections (n=5) and those deemed unsuitable for surgery (n=4) were excluded. Patients meeting the criteria for surgical candidacy with inconclusive clinical data, such as a negative MRI or discordant data (n=12), were recruited for a comprehensive MRI evaluation. This evaluation included high-resolution 3D T1-weighted scans for hippocampal/amygdala (HA) quantitative volumetry, high-resolution 3D FLAIR to facilitate lesion detection, and functional magnetic resonance imaging (fMRI) for language lateralization. The benefits of this additional data were documented in a follow-up questionnaire during the reevaluation of the patients.Results: Following our multimodal assessment, all previously discussed surgery candidates were now deemed suitable or could proceed to next assessment steps (n=12). The protocol identified previously unseen imaging abnormalities (n=4) or hippocampal asymmetry (n=2) and provided language laterality information useful in clinical management (n=12).Conclusions: Our findings demonstrate that these advanced neuroimaging modalities can be introduced into clinical practice at a newly established epilepsy surgery center and provide valuable information to benefit patient care.Funding: Queen’s University Faculty of Health Sciences