Abstract
BackgroundStereoelectroencephalography (SEEG) allows the identification of deep-seated seizure foci and determination of the epileptogenic zone (EZ) in drug-resistant epilepsy (DRE) patients. We evaluated the accuracy and treatment-associated morbidity of frameless VarioGuide® (VG) neuronavigation-guided depth electrode (DE) implantations.MethodsWe retrospectively identified all consecutive adult DRE patients, who underwent VG-neuronavigation DE implantations, between March 2013 and April 2019. Clinical data were extracted from the electronic patient charts. An interdisciplinary team agreed upon all treatment decisions. We performed trajectory planning with iPlan® Cranial software and DE implantations with the VG system. Each electrode’s accuracy was assessed at the entry (EP), the centre (CP) and the target point (TP). We conducted correlation analyses to identify factors associated with accuracy.ResultsThe study population comprised 17 patients (10 women) with a median age of 32.0 years (range 21.0–54.0). In total, 220 DEs (median length 49.3 mm, range 25.1–93.8) were implanted in 21 SEEG procedures (range 3–16 DEs/surgery). Adequate signals for postoperative SEEG were detected for all but one implanted DEs (99.5%); in 15/17 (88.2%) patients, the EZ was identified and 8/17 (47.1%) eventually underwent focus resection. The mean deviations were 3.2 ± 2.4 mm for EP, 3.0 ± 2.2 mm for CP and 2.7 ± 2.0 mm for TP. One patient suffered from postoperative SEEG-associated morbidity (i.e. conservatively treated delayed bacterial meningitis). No mortality or new neurological deficits were recorded.ConclusionsThe accuracy of VG-SEEG proved sufficient to identify EZ in DRE patients and associated with a good risk-profile. It is a viable and safe alternative to frame-based or robotic systems.
Highlights
Resection of the epileptogenic zone (EZ) remains the treatment of choice in drug-resistant focal epilepsy (DRE) patients [36, 48]
It is quintessential to reliably identify the EZ prior to epilepsy surgery, and stereoelectroencephalography (SEEG) by means of depth electrode (DE) implantation has been established as the “gold standard” for this purpose [3, 6, 11, 30, 34, 39, 54, 55, 57, 62]
DE implantations are performed by frame-based techniques, or more recently by robotic trajectory guidance systems, which both have been found to result in excellent accuracy [1, 2, 4, 7, 10, 12, 17, 20, 25,26,27,28, 32, 38, 40, 43, 47, 49,50,51,52,53, 56, 58, 67]
Summary
Resection of the epileptogenic zone (EZ) remains the treatment of choice in drug-resistant focal epilepsy (DRE) patients [36, 48]. DE implantations are performed by frame-based techniques, or more recently by robotic trajectory guidance systems, which both have been found to result in excellent accuracy [1, 2, 4, 7, 10, 12, 17, 20, 25,26,27,28, 32, 38, 40, 43, 47, 49,50,51,52,53, 56, 58, 67] These techniques, are not available in all neurosurgical departments, and frameless neuronavigation-guided SEEG may represent a possible alternative. We evaluated the accuracy and treatment-associated morbidity of frameless VarioGuide® (VG) neuronavigation-guided depth electrode (DE) implantations
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