Abstract
BACKGROUND:Stereoelectroencephalography (SEEG) is an invasive diagnostic procedure in epilepsy surgery that is usually implemented with frame-based methods.OBJECTIVE:To describe a new technique of frameless SEEG and report a prospective case series at a single center.METHODS:Image integration and planning of electrode trajectories were performed preoperatively on specialized software and exported to a Medtronic S7 StealthStation. Trajectories were implemented by frameless stereotaxy using percutaneous drilling and bolt insertion.RESULTS:Twenty-two patients went this technique, with the insertion of 187 intracerebral electrodes. Of 187 electrodes, 175 accurately reached their neurophysiological target, as measured by postoperative computed tomography reconstruction and multimodal image integration with preoperative magnetic resonance imaging. Four electrodes failed to hit their target due to extradural deflection, and 3 were subsequently resited satisfactorily. Eight electrodes were off target by a mean of 3.6 mm (range, 0.9-6.8 mm) due to a combination of errors in bolt trajectory implementation and bending of the electrode. There was 1 postoperative hemorrhage that was clinically asymptomatic and no postoperative infections. Sixteen patients were offered definitive cortical resections, and 6 patients were excluded from resective surgery.CONCLUSION:Frameless SEEG is a novel and safe method for implementing SEEG and is easily translated into clinical practice.ABBREVIATIONS:EA, accuracy of electrode deliverySEEG, stereoelectroencephalography
Highlights
Stereoelectroencephalography (SEEG) is an invasive diagnostic procedure in epilepsy surgery that is usually implemented with frame-based methods
We describe our technique and experience in the implementation of frameless SEEG at a single center
Patients underwent routine presurgical evaluation for epilepsy surgery at the National Hospital for Neurology and Neurosurgery, and individuals needing SEEG were selected on a case-by-case basis after a multidisciplinary team meeting and subsequent focused strategy meeting led by neurophysiologists
Summary
Stereoelectroencephalography (SEEG) is an invasive diagnostic procedure in epilepsy surgery that is usually implemented with frame-based methods. METHODS: Image integration and planning of electrode trajectories were performed preoperatively on specialized software and exported to a Medtronic S7 StealthStation. Trajectories were implemented by frameless stereotaxy using percutaneous drilling and bolt insertion. RESULTS: Twenty-two patients went this technique, with the insertion of 187 intracerebral electrodes. Of 187 electrodes, 175 accurately reached their neurophysiological target, as measured by postoperative computed tomography reconstruction and multimodal image integration with preoperative magnetic resonance imaging. Eight electrodes were off target by a mean of 3.6 mm (range, 0.9-6.8 mm) due to a combination of errors in bolt trajectory implementation and bending of the electrode. CONCLUSION: Frameless SEEG is a novel and safe method for implementing SEEG and is translated into clinical practice
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