Multimodal imaging integration and stereotactic intracerebral electrode insertion in the investigation of drug resistant epilepsy.

Abstract

Insertion of intracerebral electrodes for EEG recording is sometimes necessary during the pre-operative evaluation of patients with drug resistant epilepsy to define the site of seizure onsets. The precise and accurate placement of the electrodes requires a stereotactic technique of insertion based on correlated information derived from computerised imaging and stereotactic angiography. Described methods of multimodal stereotactic image integration present limitations in terms of satisfactory relocation and ability to spread data acquisition over a period of time. An alternative method of stereotactic acquisition of multimodal image information using the Gill-Thomas stereotactic repeat localiser is presented. Digital Angiographic (DSA), Computerised (CT) and Magnetic Resonance Imaging (MRI) data were correlated and used for target selection. The positional accuracy of the electrodes was confirmed repeatedly during the recording period with standard radiographic and MRI means and found to be satisfactory. There were no permanent complications in any of the patients included in the study. Stereoangiography correlative to computerised neuro-imaging offered a high degree of safety during the operation. Non-invasive relocation was an important feature of the combined system which was particularly helpful and duly appreciated by the patients. The temporal freedom provided during the investigative and operative period offers the advantage of an unhurried multi-image integration and targeting combined with less discomfort for the patient. The positional accuracy of the electrodes was easily verified during the post-operative period and this information added to the electroence-phalographic localising value of the technique.