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Stereotactic electroencephalography. Clin Neurol Neurosurg 2020; 189:105640. [DOI: 10.1016/j.clineuro.2019.105640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 11/23/2022]
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Hadji SE, Moccia S, Scorza D, Rizzi M, Cardinale F, Baselli G, Momi ED. Brain-vascular segmentation for SEEG planning via a 3D fully-convolutional neural network. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1014-1017. [PMID: 31946065 DOI: 10.1109/embc.2019.8857456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Three dimensional visualization of vascular structures can assist clinicians in preoperative planning, intra-operative guidance, and post-operative decision-making. The goal of this work is to provide an automatic, accurate and fast method for brain vessels segmentation in Contrast Enhanced Cone Beam Computed Tomography (CE-CBCT) dataset based on a residual Fully Convolutional Neural Network (FCNN). The proposed NN embeds in an encoder-decoder architecture residual elements which decreases the vanishing effect due to deep architecture while accelerating the convergence. Moreover, a two-stage training has been proposed as a countermeasure for the unbalanced nature of the dataset. The FCNN training was performed on 20 CE-CBCT volumes exploiting mini-batch gradient descent and the Adam optimizer. Binary cross-entropy was used as loss function. Performance evaluation was conducted considering 5 datasets. A median value of Dice, Precision and Recall of 0.79, 0.8 and 0.69 were obtained with respect to manual annotations.
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203
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Remick M, Ibrahim GM, Mansouri A, Abel TJ. Patient phenotypes and clinical outcomes in invasive monitoring for epilepsy: An individual patient data meta-analysis. Epilepsy Behav 2020; 102:106652. [PMID: 31770717 DOI: 10.1016/j.yebeh.2019.106652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Invasive monitoring provides valuable clinical information in patients with drug-resistant epilepsy (DRE). However, there is no clear evidence indicating either stereoelectroencephalography (SEEG) or subdural electrodes (SDE) as the optimal method. Our goal was to examine differences in postresection seizure freedom rates between SEEG- and SDE-informed resective epilepsy surgeries. Additionally, we aimed to determine potential clinical indicators for SEEG or SDE monitoring in patients with drug-resistant epilepsy. METHODS A systematic literature review was performed in which we searched for primary articles using keywords such as "electroencephalography", "intracranial grid", and "epilepsy." Only studies containing individual patient data (IPD) were included for analysis. A one-stage IPD meta-analysis was performed to determine differences in rates of seizure freedom (International League Against Epilepsy (ILAE) guidelines and Engel classification) and resection status between SEEG and SDE patients. A Cox proportional-hazards regression was performed to determine the effect of time on seizure freedom status. Additionally, a principal component analysis was performed to investigate primary drivers of variance between these two groups. RESULTS This IPD meta-analysis compared differences between SEEG and SDE invasive monitoring techniques in 595 patients from 33 studies. Our results demonstrate that while there was no difference in seizure freedom rates regardless of resection (p = 0.0565), SEEG was associated with a lower rate of resection compared with SDE (82.00% SEEG, 92.74% SDE, p = 0.0002). Additionally, while SDE was associated with a higher rate of postresection seizure freedom (54.04% SEEG, 64.32% SDE, p = 0.0247), the difference between seizure freedom rates following SEEG- or SDE-informed resection decreased with long-term follow-up. A principal component analysis showed that cases resulting in SEEG were associated with lower risk of morbidity than SDE cases, which were strongly collinear with multiple subpial transections, anterior temporal lobectomy, amygdalectomy, and hippocampectomy. SIGNIFICANCE In this IPD meta-analysis of SEEG and SDE invasive monitoring techniques, SEEG and SDE were associated with similar rates of seizure freedom at latest follow-up. The former was associated with lower rates of resection. Furthermore, the clinical phenotypes of patients undergoing SEEG monitoring was associated with lower rates of complications. Future long-term prospective registries of IPD are promising options for clarifying the differences in these intracranial monitoring techniques as well as the unique patient phenotypes that may be associated with their indication.
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Affiliation(s)
- Madison Remick
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - George M Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada; Division of Neurosurgery, Hospital for Sick Children, Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Canada
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State University, Hershey, PA, USA
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
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204
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Bollard L, Moore E, Paff R. Epilepsy Surgery: A Paediatric Perspective. AUSTRALASIAN JOURNAL OF NEUROSCIENCE 2020. [DOI: 10.21307/ajon-2020-007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Fujimoto A, Sakakura K, Ichikawa N, Okanishi T. Easy anchoring and smaller skin incision procedure for neuronavigation-based frameless stereoelectroencephalography. J Clin Neurosci 2019; 74:220-224. [PMID: 31839385 DOI: 10.1016/j.jocn.2019.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/01/2019] [Indexed: 01/03/2023]
Abstract
Epilepsy surgery uses both depth electrodes (DEs) and subdural electrodes (SE). DEs have mainly been developed and used in Europe. As we are able to use the DEs safely due to the current advanced level of technology, use of DEs has been increasing rapidly over the last decade. Unlike placement of SEs, which simply requires craniotomy, DE placement generally requires stereotactic techniques such as frame-based stereotactic or robotic arm-based methods. However, such methods are not always available at every epilepsy center. We therefore invented guide pipes for accurate DE placement. With this guide pipe and neuronavigation-based (NB) DE placement system, we are able to place DEs accurately. However, the disadvantages of our original procedure were a relatively large skin incision and the difficulty in anchoring DEs. The purpose of this technical note is to introduce a method to perform NB DE placement with a smaller skin incision and simple anchoring procedure. As we could make the skin incision smaller and achieved easier anchoring of DEs using a titanium plate, we hope this procedure will help facilities to perform DE placement with neuronavigation systems.
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Affiliation(s)
- Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Japan.
| | - Kazuki Sakakura
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Japan
| | - Naoki Ichikawa
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Japan
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Japan
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206
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Quantitative Signal Characteristics of Electrocorticography and Stereoelectroencephalography: The Effect of Contact Depth. J Clin Neurophysiol 2019; 36:195-203. [PMID: 30925509 PMCID: PMC6493682 DOI: 10.1097/wnp.0000000000000577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Purpose: Patients undergoing epilepsy surgery often require invasive EEG, but few studies have examined the signal characteristics of contacts on the surface of the brain (electrocorticography, ECOG) versus depth contacts, used in stereoelectroencephalography (SEEG). As SEEG and ECOG have significant differences in complication rates, it is important to determine whether both modalities produce similar signals for analysis, to ultimately guide management of medically intractable epilepsy. Methods: Twenty-seven patients who underwent SEEG (19), ECOG (6), or both (2) were analyzed for quantitative measures of activity including spectral power and phase–amplitude coupling during approximately 1 hour of wakefulness. The position of the contacts was calculated by coregistering the postoperative computed tomography with a reconstructed preoperative MRI. Using two types of referencing schemes—local versus common average reference—the brain regions where any quantitative measure differed systematically with contact depth were established. Results: Using even the most permissive statistical criterion, few quantitative measures were significantly correlated with contact depth in either ECOG or SEEG contacts. The factors that predicted changes in spectral power and phase–amplitude coupling with contact depth were failing to baseline correct spectral power measures, use of a local rather than common average reference, using baseline correction for phase–amplitude coupling measures, and proximity of other grey matter structures near the region where the contact was located. Conclusions: The signals recorded by ECOG and SEEG have very similar spectral power and phase–amplitude coupling, suggesting that both modalities are comparable from an electrodiagnostic standpoint in delineation of the epileptogenic network.
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207
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Ross L, Naduvil AM, Bulacio JC, Najm IM, Gonzalez-Martinez JA. Stereoelectroencephalography-Guided Laser Ablations in Patients With Neocortical Pharmacoresistant Focal Epilepsy: Concept and Operative Technique. Oper Neurosurg (Hagerstown) 2019; 15:656-663. [PMID: 29554343 DOI: 10.1093/ons/opy022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 01/23/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Laser ablation surgery has had encouraging results in the treatment of multiple intracranial diseases including primary and metastatic brain tumors, radiation necrosis, and epilepsy. The use of the stereoelectroencephalography (SEEG) method in combination with laser thermocoagulation therapy with the goal of modulating epileptic networks in patients with neocortical nonlesional phamacoresistant epilepsy has not been previously described. OBJECTIVE To describe the novel methodological and conceptual aspects related to SEEG-guided laser ablations in patients with magnetic resonance imaging (MRI)-negative pharmacoresistant neocortical focal epilepsy. METHODS Guided by previous SEEG intracranial data, a laser ablation probe was inserted by using a robotic guidance device in a 17-yr-old medically refractory epilepsy patient with difficult to localize seizures and nonlesional MRI. The laser applicator position was confirmed by MRI, targeting the left mesial rostral superior frontal gyrus. The ablation was performed under multiplanar digital imaging views and real-time thermal imaging and treatment estimates in each plane. A postablation MRI (contrasted T1 sequence) confirmed the ablation's location and size. RESULTS The entire procedure was achieved in approximately 100 min. The actual ablation was performed in less than 3 min. Approximately, additional 30 min preoperatively were used for positioning and robot registration. Precise placement of laser application (in comparison with preplanned trajectories) was achieved using the robotic guidance and confirmed by the intraoperative magnetic resonance images. No complications were reported. The patient has been seizure-free since surgery. The follow-up period is 20 mo. Two additional patients, treated with similar methodology, are also described. CONCLUSION The preliminary experience with the described method shows the feasibility of a unique combination of the SEEG methodology with laser thermocoagulation in patients with neocortical MRI-negative pharmacoresistant focal epilepsy.
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Affiliation(s)
- Louis Ross
- Department of Neurosurgery, Cleveland Clinic, Ohio
| | | | | | - Imad M Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
| | - Jorge A Gonzalez-Martinez
- Department of Neurosurgery, Cleveland Clinic, Ohio.,Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
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Dewan MC, Shults R, Hale AT, Sukul V, Englot DJ, Konrad P, Yu H, Neimat JS, Rodriguez W, Dawant BM, Pallavaram S, Naftel RP. Stereotactic EEG via multiple single-path omnidirectional trajectories within a single platform: institutional experience with a novel technique. J Neurosurg 2019; 129:1173-1181. [PMID: 29243976 DOI: 10.3171/2017.6.jns17881] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/13/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEStereotactic electroencephalography (SEEG) is being used with increasing frequency to interrogate subcortical, cortical, and multifocal epileptic foci. The authors describe a novel technique for SEEG in patients with suspected epileptic foci refractory to medical management.METHODSIn the authors' technique, standard epilepsy evaluation and neuroimaging are used to create a hypothesis-driven SEEG plan, which informs the 3D printing of a novel single-path, multiple-trajectory, omnidirectional platform. Following skull-anchor platform fixation, electrodes are sequentially inserted according to the preoperative plan. The authors describe their surgical experience and technique based on a review of all cases, adult and pediatric, in which patients underwent invasive epilepsy monitoring via SEEG during an 18-month period at Vanderbilt University Medical Center. Platform and anatomical variables influencing localization error were evaluated using multivariate linear regression.RESULTSUsing this novel technology, 137 electrodes were inserted in 15 patients with focal epilepsy with favorable recording results and no clinical complications. The mean entry point localization error was 1.42 mm (SD 0.98 mm), and the mean target point localization error was 3.36 mm (SD 2.68 mm). Platform distance, electrode trajectory angle, and intracranial distance, but not skull thickness, were independently associated with localization error.CONCLUSIONSThe multiple-trajectory, single-path, omnidirectional platform offers satisfactory accuracy and favorable clinical results, while avoiding cumbersome frames and prohibitive up-front costs associated with other SEEG technologies.
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Affiliation(s)
- Michael C Dewan
- 1Department of Neurological Surgery, Vanderbilt University Medical Center
| | - Robert Shults
- 2Department of Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee; and
| | - Andrew T Hale
- 1Department of Neurological Surgery, Vanderbilt University Medical Center
| | - Vishad Sukul
- 1Department of Neurological Surgery, Vanderbilt University Medical Center
| | - Dario J Englot
- 1Department of Neurological Surgery, Vanderbilt University Medical Center
| | - Peter Konrad
- 1Department of Neurological Surgery, Vanderbilt University Medical Center
| | - Hong Yu
- 1Department of Neurological Surgery, Vanderbilt University Medical Center
| | - Joseph S Neimat
- 3Department of Neurological Surgery, University of Louisville, Kentucky
| | - William Rodriguez
- 2Department of Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee; and
| | - Benoit M Dawant
- 2Department of Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee; and
| | - Srivatsan Pallavaram
- 2Department of Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee; and
| | - Robert P Naftel
- 1Department of Neurological Surgery, Vanderbilt University Medical Center
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Vakharia VN, Sparks R, Miserocchi A, Vos SB, O'Keeffe A, Rodionov R, McEvoy AW, Ourselin S, Duncan JS. Computer-Assisted Planning for Stereoelectroencephalography (SEEG). Neurotherapeutics 2019; 16:1183-1197. [PMID: 31432448 PMCID: PMC6985077 DOI: 10.1007/s13311-019-00774-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Stereoelectroencephalography (SEEG) is a diagnostic procedure in which multiple electrodes are stereotactically implanted within predefined areas of the brain to identify the seizure onset zone, which needs to be removed to achieve remission of focal epilepsy. Computer-assisted planning (CAP) has been shown to improve trajectory safety metrics and generate clinically feasible trajectories in a fraction of the time needed for manual planning. We report a prospective validation study of the use of EpiNav (UCL, London, UK) as a clinical decision support software for SEEG. Thirteen consecutive patients (125 electrodes) undergoing SEEG were prospectively recruited. EpiNav was used to generate 3D models of critical structures (including vasculature) and other important regions of interest. Manual planning utilizing the same 3D models was performed in advance of CAP. CAP was subsequently employed to automatically generate a plan for each patient. The treating neurosurgeon was able to modify CAP generated plans based on their preference. The plan with the lowest risk score metric was stereotactically implanted. In all cases (13/13), the final CAP generated plan returned a lower mean risk score and was stereotactically implanted. No complication or adverse event occurred. CAP trajectories were generated in 30% of the time with significantly lower risk scores compared to manually generated. EpiNav has successfully been integrated as a clinical decision support software (CDSS) into the clinical pathway for SEEG implantations at our institution. To our knowledge, this is the first prospective study of a complex CDSS in stereotactic neurosurgery and provides the highest level of evidence to date.
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Affiliation(s)
- Vejay N Vakharia
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK.
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK.
| | - Rachel Sparks
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, UK
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - Sjoerd B Vos
- Wellcome Trust EPSRC Interventional and Surgical Sciences, University College London, London, UK
| | - Aidan O'Keeffe
- Department of Statistical Science, University College London, London, UK
| | - Roman Rodionov
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
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210
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Arya R, Ervin B, Dudley J, Buroker J, Rozhkov L, Scholle C, Horn PS, Vannest J, Byars AW, Leach JL, Mangano FT, Greiner HM, Holland KD, Glauser TA. Electrical stimulation mapping of language with stereo-EEG. Epilepsy Behav 2019; 99:106395. [PMID: 31422309 DOI: 10.1016/j.yebeh.2019.06.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We prospectively validated stereo-electroencephalography (EEG) electrical stimulation mapping (ESM) of language against a reference standard of meta-analytic functional magnetic resonance imaging (fMRI) framework (Neurosynth). METHODS Language ESM was performed using 50 Hz, biphasic, bipolar, stimulation at 1-8 mA, with a picture naming task. Electrode contacts (ECs) were scored as ESM+ if ESM interfered with speech/language function. For each patient, presurgical MRI was transformed to a standard space and coregistered with computed tomographic (CT) scan to obtain EC locations. After whole-brain parcellation, this fused image data were intersected with three-dimensional language fMRI (Neurosynth), and each EC was classified as lying within/outside the fMRI language parcel. Diagnostic odds ratio (DOR) and other indices were estimated. Current thresholds for language inhibition and after-discharges (ADs) were analyzed using multivariable linear mixed models. RESULTS In 10 patients (5 females), aged 5.4-21.2 years, speech/language inhibition was noted with ESM on 87/304 (29%) ECs. Stereo-EEG language ESM was a valid classifier of fMRI (Neurosynth) language sites (DOR: 9.02, p < 0.0001), with high specificity (0.87) but poor sensitivity (0.57). Similar diagnostic indices were seen for ECs in frontal or posterior regions, and gray or white matter. Language threshold (3.1 ± 1.5 mA) was lower than AD threshold (4.0 ± 2.0 mA, p = 0.0001). Language and AD thresholds decreased with age and intelligence quotient. Electrical stimulation mapping triggered seizures/auras represented patients' habitual semiology with 1 Hz stimulation. CONCLUSIONS Stereo-EEG ESM can reliably identify cerebral parcels with/without language function but may under detect all language sites. We suggest a 50-Hz stimulation protocol for language ESM with stereo-EEG.
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Affiliation(s)
- Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Brian Ervin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Electrical Engineering and Computing Systems, University of Cincinnati, Cincinnati, OH, USA
| | - Jonathan Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jason Buroker
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Clinical Engineering, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leonid Rozhkov
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Craig Scholle
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer Vannest
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anna W Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James L Leach
- Division of Pediatric Neuro-radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Francesco T Mangano
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hansel M Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katherine D Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tracy A Glauser
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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211
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Optimized SEEG-guided radiofrequency thermocoagulation for mesial temporal lobe epilepsy with hippocampal sclerosis. Seizure 2019; 71:304-311. [DOI: 10.1016/j.seizure.2019.08.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/17/2019] [Accepted: 08/23/2019] [Indexed: 02/03/2023] Open
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Whiting AC, Catapano JS, Zavala B, Walker CT, Godzik J, Chen T, Smith KA. Doing More with Less: A Minimally Invasive, Cost-Conscious Approach to Stereoelectroencephalography. World Neurosurg 2019; 133:34-40. [PMID: 31541761 DOI: 10.1016/j.wneu.2019.09.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Stereoelectroencephalography (SEEG) is a commonly used technique for mapping the epileptogenic zone before epilepsy surgery. Many SEEG depth electrode implantation techniques involve the use of extensive technological equipment and shaving of the patient's entire head before electrode implantation. Our goal was to evaluate an SEEG depth electrode implantation technique that used readily available cost-effective neurosurgical equipment, was minimally invasive in nature, and required negligible hair shaving. METHODS Data on demographic characteristics, operative time, hemorrhagic complications, implantation complications, infection, morbidity, and mortality among patients who underwent this procedure were reviewed retrospectively. RESULTS Between April 2016 and March 2018, 23 patients underwent implantation of 213 depth electrodes with use of this technique. Mean (SD) operative time was 123 (32) minutes (range, 66-181 minutes). A mean (SD) of 9.3 (1.4) electrodes were placed for each patient (range, 8-13 electrodes). Two of the 213 electrodes (0.9%) were associated with postimplantation asymptomatic hemorrhage. One of the 213 electrodes (0.5%) was placed extradurally or incorrectly. None of the 213 electrodes was associated with symptomatic complications. No patients experienced infectious complications at any point in the preoperative, perioperative, or postoperative stages. CONCLUSIONS This minimally invasive, cost-effective technique for SEEG depth electrode implantation is a safe, efficient method that uses readily available basic neurosurgical equipment. This technique may be useful in neurosurgery centers with more limited resources. This study suggests that leaving the patient's hair largely intact throughout the procedure does not pose an additional infection risk.
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Affiliation(s)
- Alexander C Whiting
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Baltazar Zavala
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Corey T Walker
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Tsinsue Chen
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kris A Smith
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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213
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Fomenko A, Serletis D. Robotic Stereotaxy in Cranial Neurosurgery: A Qualitative Systematic Review. Neurosurgery 2019; 83:642-650. [PMID: 29253265 DOI: 10.1093/neuros/nyx576] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/01/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Modern-day stereotactic techniques have evolved to tackle the neurosurgical challenge of accurately and reproducibly accessing specific brain targets. Neurosurgical advances have been made in synergy with sophisticated technological developments and engineering innovations such as automated robotic platforms. Robotic systems offer a unique combination of dexterity, durability, indefatigability, and precision. OBJECTIVE To perform a systematic review of robotic integration for cranial stereotactic guidance in neurosurgery. Specifically, we comprehensively analyze the strengths and weaknesses of a spectrum of robotic technologies, past and present, including details pertaining to each system's kinematic specifications and targeting accuracy profiles. METHODS Eligible articles on human clinical applications of cranial robotic-guided stereotactic systems between 1985 and 2017 were extracted from several electronic databases, with a focus on stereotactic biopsy procedures, stereoelectroencephalography, and deep brain stimulation electrode insertion. RESULTS Cranial robotic stereotactic systems feature serial or parallel architectures with 4 to 7 degrees of freedom, and frame-based or frameless registration. Indications for robotic assistance are diversifying, and include stereotactic biopsy, deep brain stimulation and stereoelectroencephalography electrode placement, ventriculostomy, and ablation procedures. Complication rates are low, and mainly consist of hemorrhage. Newer systems benefit from increasing targeting accuracy, intraoperative imaging ability, improved safety profiles, and reduced operating times. CONCLUSION We highlight emerging future directions pertaining to the integration of robotic technologies into future neurosurgical procedures. Notably, a trend toward miniaturization, cost-effectiveness, frameless registration, and increasing safety and accuracy characterize successful stereotactic robotic technologies.
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Affiliation(s)
- Anton Fomenko
- Manitoba Neurosurgery Laboratory, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Section of Neurosurgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Demitre Serletis
- Manitoba Neurosurgery Laboratory, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Section of Neurosurgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
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Dührsen L, Sauvigny T, Ricklefs FL, Hamel W, Koeppen JA, Hebel JM, Lanz M, Martens T. Decision-making in temporal lobe epilepsy surgery based on invasive stereo-electroencephalography (sEEG). Neurosurg Rev 2019; 43:1403-1408. [PMID: 31502028 DOI: 10.1007/s10143-019-01175-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 11/27/2022]
Abstract
In medical refractory temporal lobe epilepsy (TLE), the epileptogenic zone can be difficult to identify and therefore difficult to treat, especially in the absence of clear MRI pathologies and specific results from presurgical evaluation. Invasive monitoring with stereo-electroencephalography (sEEG) is a tool for a better determination of the epileptogenic zone. Here, we investigate the impact of sEEG on decision-making in temporal lobe epilepsy surgery. We reviewed patients with TLE who underwent further investigation with sEEG in our epilepsy unit. We examined specifically how sEEG findings influenced our decision regarding indication for a surgical procedure and resection volume. From 2013 to 2017, we performed 152 temporal resections in epilepsy patients. Twenty-one of these patients were designated for further preoperative investigation with sEEG due to incongruent findings in presurgical evaluation. Six patients were implanted bitemporally. In five cases, the hypothesis for the epileptogenic zone and localization had to be changed due to sEEG findings and resulted in a different tailored resection than intended. In three cases, sEEG findings led to the cancelation of the originally intended temporal resection as the epileptogenic zone was not definable or bilateral. In another three cases, the prognosis for reduction of seizures postoperatively had to be reduced due to the sEEG findings. However, the resection was performed after interdisciplinary discussion and informed consent of the patient. The examination by sEEG led to a change of plan for further treatment in 13 patients (61.9%) suffering TLE in total. Invasive monitoring with sEEG electrodes had a strong impact on decision-making for further treatment in patients suffering from temporal lobe epilepsy with incongruent findings in presurgical examination designated for epilepsy surgery. This applies to resection volumes as well as to prediction of seizure outcome.
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Affiliation(s)
- Lasse Dührsen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Center for Molecular Neurobiology, Institute for Molecular and Cellular Cognition, Hamburg, Germany
| | - Franz L Ricklefs
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes A Koeppen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jonas M Hebel
- Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Hamburg, Germany
| | - Michael Lanz
- Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Hamburg, Germany
| | - Tobias Martens
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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215
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Li K, Vakharia VN, Sparks R, Rodionov R, Vos SB, McEvoy AW, Miserocchi A, Wang M, Ourselin S, Duncan JS. Stereoelectroencephalography electrode placement: Detection of blood vessel conflicts. Epilepsia 2019; 60:1942-1948. [PMID: 31329275 PMCID: PMC6851756 DOI: 10.1111/epi.16294] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Various forms of vascular imaging are performed to identify vessels that should be avoided during stereoelectroencephalography (SEEG) planning. Digital subtraction angiography (DSA) is the gold standard for intracranial vascular imaging. DSA is an invasive investigation, and a balance is necessary to identify all clinically relevant vessels and not to visualize irrelevant vessels that may unnecessarily restrict electrode placement. We sought to estimate the size of vessels that are clinically significant for SEEG planning. METHODS Thirty-three consecutive patients who underwent 354 SEEG electrode implantations planned with computer-assisted planning and DSA segmentation between 2016 and 2018 were identified from a prospectively maintained database. Intracranial positions of electrodes were segmented from postimplantation computed tomography scans. Each electrode was manually reviewed using "probe-eye view" with the raw preoperative DSA images for vascular conflicts. The diameter of vessels and the location of conflicts were noted. Vessel conflicts identified on raw DSA images were cross-referenced against other modalities to determine whether the conflict could have been detected. RESULTS One hundred sixty-six vessel conflicts were identified between electrodes and DSA-identified vessels, with 0-3 conflicts per electrode and a median of four conflicts per patient. The median diameter of conflicting vessels was 1.3 mm (interquartile range [IQR] = 1.0-1.5 mm). The median depth of conflict was 31.0 mm (IQR = 14.3-45.0 mm) from the cortical surface. The addition of sulcal models to DSA, magnetic resonance venography (MRV), and T1 + gadolinium images, as an exclusion zone during computer-assisted planning, would have prevented the majority of vessel conflicts. We were unable to determine whether vessels were displaced or transected by the electrodes. SIGNIFICANCE Vascular segmentation from DSA images was significantly more sensitive than T1 + gadolinium or MRV images. Electrode conflicts with vessels 1-1.5 mm in size did not result in a radiologically detectable or clinically significant hemorrhage and could potentially be excluded from consideration during SEEG planning.
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Affiliation(s)
- Kuo Li
- Department of NeurosurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
- National Hospital for Neurology and Neurosurgery, Queen SquareLondonUK
- Chalfont Centre for EpilepsyChalfontUK
| | - Vejay N. Vakharia
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
- National Hospital for Neurology and Neurosurgery, Queen SquareLondonUK
- Chalfont Centre for EpilepsyChalfontUK
| | - Rachel Sparks
- School of Biomedical Engineering and Imaging SciencesSt Thomas’ HospitalKing's College LondonLondonUK
| | - Roman Rodionov
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
- National Hospital for Neurology and Neurosurgery, Queen SquareLondonUK
- Chalfont Centre for EpilepsyChalfontUK
| | - Sjoerd B. Vos
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
- Centre for Medical Image ComputingUniversity College LondonLondonUK
| | - Andrew W. McEvoy
- National Hospital for Neurology and Neurosurgery, Queen SquareLondonUK
| | - Anna Miserocchi
- National Hospital for Neurology and Neurosurgery, Queen SquareLondonUK
| | - Maode Wang
- Department of NeurosurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging SciencesSt Thomas’ HospitalKing's College LondonLondonUK
| | - John S. Duncan
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
- National Hospital for Neurology and Neurosurgery, Queen SquareLondonUK
- Chalfont Centre for EpilepsyChalfontUK
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216
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Yan H, Katz JS, Anderson M, Mansouri A, Remick M, Ibrahim GM, Abel TJ. Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review. Epilepsia 2019; 60:1960-1972. [PMID: 31423575 DOI: 10.1111/epi.16315] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Invasive monitoring is sometimes necessary to guide resective surgery in epilepsy patients, but the ideal method is unknown. In this systematic review, we assess the association of postresection seizure freedom and adverse events in stereoelectroencephalography (SEEG) and subdural electrodes (SDE). METHODS We searched three electronic databases (MEDLINE, Embase, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to January 2018 with the keywords "electroencephalography," "intracranial grid," and "epilepsy." Studies that presented primary quantitative patient data for postresection seizure freedom with at least 1 year of follow-up or complication rates of SEEG- or SDE-monitored patients were included. Two trained investigators independently collected data from eligible studies. Weighted mean differences (WMDs) with 95% confidence interval (CIs) were used as a measure of the association of SEEG or SDE with seizure freedom and with adverse event outcomes. RESULTS Of 11 462 screened records, 48 studies met inclusion criteria. These studies reported on 1973 SEEG patients and 2036 SDE patients. Our systematic review revealed SEEG was associated with 61.0% and SDE was associated with 56.4% seizure freedom after resection (WMD = +5.8%, 95% CI = 4.7-6.9%, P = .001). Furthermore, SEEG was associated with 4.8% and SDE was associated with 15.5% morbidity (WMD = -10.6%, 95% CI = -11.6 to -9.6%, P = .001). SEEG was associated with 0.2% mortality and SDE was associated with 0.4% mortality (WMD = -0.2%, 95% CI = -0.3 to -0.1%, P = .001). SIGNIFICANCE In this systematic review of SEEG and SDE invasive monitoring techniques, SEEG was associated with fewer surgical resections yet better seizure freedom outcomes in those undergoing resections. SEEG was also associated with lower mortality and morbidity than SDE. Clinical studies directly comparing these modalities are necessary to understand the relative rates of seizure freedom, morbidity, and mortality associated with these techniques.
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Affiliation(s)
- Han Yan
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joel S Katz
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Melanie Anderson
- Library and Information Services, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alireza Mansouri
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Madison Remick
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - George M Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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217
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Comparison of Functional Deficit Zone Defined by FDG PET to the Epileptogenic Zones Described in Stereo-Electroencephalograph in Drug-Resistant Epileptic Patients Treated by Surgery. Clin Nucl Med 2019; 44:526-531. [PMID: 31135520 DOI: 10.1097/rlu.0000000000002615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The purpose of presurgical assessment is to delimit the epileptogenic zone and the functional deficit zone with a brain MRI, an electroencephalograph or even a stereo-electroencephalograph (SEEG), neuropsychological evaluation, and a cerebral FDG PET. Several studies concur that the hypometabolism of FDG PET seems to be consistent with epileptogenic zones. We compared the functional deficit zone defined by FDG PET with the results of the SEEG, for each cluster electrode contact (CEC) located in the gray matter. METHODS The electrode diagram of the 15 patients (486 CECs) operated on for drug-resistant epilepsy was merged with MRI and FDG PET. The metabolisms of FDG PET and SEEG were compared using a logistic regression test. RESULTS The presence of hypometabolism resulted in a significantly higher risk of being in the seizure onset zone and the irritative zone, particularly when it was intense. Of the deeply hypometabolic CECs, 47% were in the seizure onset zone and 76% in the irritative zone. Normal metabolism resulted in a significantly higher probability of being in the healthy zone. CONCLUSIONS This study demonstrated an association between the presence of normal metabolism and the location of CECs in the healthy zone, and between the presence of pathological metabolism and the location of CECs in the seizure onset zone and the irritative zone, with metabolism abnormalities progressively more present and more intense near the seizure onset zone.
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218
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D’Agostino E, Kanter J, Song Y, Aronson JP. Stereoencephalography Electrode Placement Accuracy and Utility Using a Frameless Insertion Platform Without a Rigid Cannula. Oper Neurosurg (Hagerstown) 2019; 18:409-416. [DOI: 10.1093/ons/opz200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/16/2019] [Indexed: 11/12/2022] Open
Abstract
AbstractBACKGROUNDImplantation of depth electrodes to localize epileptogenic foci in patients with drug-resistant epilepsy can be accomplished using traditional rigid frame-based, custom frameless, and robotic stereotactic systems.OBJECTIVETo evaluate the accuracy of electrode implantation using the FHC microTargeting platform, a custom frameless platform, without a rigid insertion cannula.METHODSA total of 182 depth electrodes were implanted in 13 consecutive patients who underwent stereoelectroencephalography (SEEG) for drug-resistant epilepsy using the microTargeting platform and depth electrodes without a rigid guide cannula. MATLAB was utilized to evaluate targeting accuracy. Three manual coordinate measurements with high inter-rater reliability were averaged.RESULTSPatients were predominantly male (77%) with average age 35.62 (SD 11.0, range 21-57) and average age of epilepsy onset at 13.4 (SD 7.2, range 3-26). A mean of 14 electrodes were implanted (range 10-18). Mean operative time was 144 min (range 104-176). Implantation of 3 out of 182 electrodes resulted in nonoperative hemorrhage (2 small subdural hematomas and one small subarachnoid hemorrhage). Putative location of onset was identified in all patients. We demonstrated a median lateral target point localization error (LTPLE) of 3.95 mm (IQR 2.18-6.23), a lateral entry point localization error (LEPLE) of 1.98 mm (IQR 1.2-2.85), a target depth error of 1.71 mm (IQR 1.03-2.33), and total target point localization error (TPLE) of 4.95 mm (IQR 2.98-6.85).CONCLUSIONUtilization of the FHC microTargeting platform without the use of insertion cannulae is safe, effective, and accurate. Localization of seizure foci was accomplished in all patients and accuracy of depth electrode placement was satisfactory.
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Affiliation(s)
- Erin D’Agostino
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - John Kanter
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Yinchen Song
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Joshua P Aronson
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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219
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The Effect of Vascular Segmentation Methods on Stereotactic Trajectory Planning for Drug-Resistant Focal Epilepsy: A Retrospective Cohort Study. World Neurosurg X 2019; 4:100057. [PMID: 31650126 PMCID: PMC6804655 DOI: 10.1016/j.wnsx.2019.100057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 11/23/2022] Open
Abstract
Background Stereotactic neurosurgical procedures carry a risk of intracranial hemorrhage, which may result in significant morbidity and mortality. Vascular imaging is crucial for planning stereotactic procedures to prevent conflicts with intracranial vasculature. There is a wide range of vascular imaging methods used for stereoelectroencephalography (SEEG) trajectory planning. Computer-assisted planning (CAP) improves planning time and trajectory metrics. We aimed to quantify the effect of different vascular imaging protocols on CAP trajectories for SEEG. Methods Ten patients who had undergone SEEG (95 electrodes) following preoperative acquisition of gadolinium-enhanced magnetic resonance imaging (MR + Gad), magnetic resonance angiography and magnetic resonance angiography (MRV + MRA), and digital subtraction catheter angiography (DSA) were identified from a prospectively maintained database. SEEG implantations were planned using CAP using DSA segmentations as the gold standard. Strategies were then recreated using MRV + MRA and MR + Gad to define the “apparent” and “true” risk scores associated with each modality. Vessels of varying diameter were then iteratively removed from the DSA segmentation to identify the size at which all 3 vascular modalities returned the same safety metrics. Results CAP performed using DSA vessel segmentations resulted in significantly lower “true” risk scores and greater minimum distances from vasculature compared with the “true” risk associated with MR + Gad and MRV + MRA. MRV + MRA and MR + Gad returned similar risk scores to DSA when vessels <2 mm and <4 mm were not considered, respectively. Conclusions Significant variability in vascular imaging and trajectory planning practices exist for SEEG. CAP performed with MR + Gad or MRV + MRA alone returns “falsely” lower risk scores compared with DSA. It is unclear whether DSA is oversensitive and thus restricting potential trajectories.
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Key Words
- CAP, Computer-assisted planning
- Computer-assisted planning
- DSA, Digital subtraction catheter angiography
- EpiNav
- Epilepsy
- GIF, Geodesic information flows
- GM, Gray matter
- MD, Minimum distance
- MPRAGE, Magnetization prepared-rapid gradient echo
- MRA, Magnetic resonance angiography
- MRV, Magnetic resonance venography
- MR + Gad, Gadolinium-enhanced magnetic resonance imaging
- ROI, Region of interest
- RS, Risk score
- SEEG, Stereoelectroencephalography
- Stereoelectroencephalography
- Vascular segmentation
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220
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Surgical outcomes related to invasive EEG monitoring with subdural grids or depth electrodes in adults: A systematic review and meta-analysis. Seizure 2019; 70:12-19. [DOI: 10.1016/j.seizure.2019.06.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 01/05/2023] Open
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221
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Cardinale F, Rizzi M, Vignati E, Cossu M, Castana L, d’Orio P, Revay M, Costanza MD, Tassi L, Mai R, Sartori I, Nobili L, Gozzo F, Pelliccia V, Mariani V, Lo Russo G, Francione S. Stereoelectroencephalography: retrospective analysis of 742 procedures in a single centre. Brain 2019; 142:2688-2704. [DOI: 10.1093/brain/awz196] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractThis retrospective description of a surgical series is aimed at reporting on indications, methodology, results on seizures, outcome predictors and complications from a 20-year stereoelectroencephalography (SEEG) activity performed at a single epilepsy surgery centre. Prospectively collected data from a consecutive series of 742 SEEG procedures carried out on 713 patients were reviewed and described. Long-term seizure outcome of SEEG-guided resections was defined as a binomial variable: absence (ILAE classes 1–2) or recurrence (ILAE classes 3–6) of disabling seizures. Predictors of seizure outcome were analysed by preliminary uni/bivariate analyses followed by multivariate logistic regression. Furthermore, results on seizures of these subjects were compared with those obtained in 1128 patients operated on after only non-invasive evaluation. Survival analyses were also carried out, limited to patients with a minimum follow-up of 10 years. Resective surgery has been indicated for 570 patients (79.9%). Two-hundred and seventy-nine of 470 patients operated on (59.4%) were free of disabling seizures at least 2 years after resective surgery. Negative magnetic resonance and post-surgical lesion remnant were significant risk factors for seizure recurrence, while type II focal cortical dysplasia, balloon cells, glioneuronal tumours, hippocampal sclerosis, older age at epilepsy onset and periventricular nodular heterotopy were significantly associated with seizure freedom. Twenty-five of 153 patients who underwent radio-frequency thermal coagulation (16.3%) were optimal responders. Thirteen of 742 (1.8%) procedures were complicated by unexpected events, including three (0.4%) major complications and one fatality (0.1%). In conclusion, SEEG is a safe and efficient methodology for invasive definition of the epileptogenic zone in the most challenging patients. Despite the progressive increase of MRI-negative cases, the proportion of seizure-free patients did not decrease throughout the years.
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Affiliation(s)
- Francesco Cardinale
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Michele Rizzi
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Elena Vignati
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Massimo Cossu
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Laura Castana
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Piergiorgio d’Orio
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Neuroscience Institute, CNR, Parma, Italy
| | - Martina Revay
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Neurosurgery Residency Program, University of Milan, Milan, Italy
| | - Martina Della Costanza
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Neurosurgery Unit, Polytechnic, University of Marche, Ancona, Italy
| | - Laura Tassi
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Roberto Mai
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Ivana Sartori
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS ‘G. Gaslini’ Institute, DINOGMI, University of Genoa, Genoa, Italy
| | - Francesca Gozzo
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Veronica Pelliccia
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Department of Neuroscience, University of Parma, Parma, Italy
| | - Valeria Mariani
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giorgio Lo Russo
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Stefano Francione
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
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222
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Lee KH, Lee YJ, Seo JH, Baumgartner JE, Westerveld M. Epilepsy Surgery in Children versus Adults. J Korean Neurosurg Soc 2019; 62:328-335. [PMID: 31085959 PMCID: PMC6514317 DOI: 10.3340/jkns.2019.0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/24/2019] [Indexed: 11/29/2022] Open
Abstract
Epilepsy is one of the most common chronic neurological disorder affecting 6–7 per 1000 worldwide. Nearly one-third of patients with newly diagnosed epilepsy continue to have recurrent seizures despite adequate trial of more than two anti-seizure drugs : drug-resistant epilepsy (DRE). Children with DRE often experience cognitive and psychosocial co-morbidities requiring more urgent and aggressive treatment than adults. Epilepsy surgery can result in seizure-freedom in approximately two-third of children with improvement in cognitive development and quality of life. Understanding fundamental differences in etiology, co-morbidity, and neural plasticity between children and adults is critical for appropriate selection of surgical candidates, appropriate presurgical evaluation and surgical approach, and improved overall outcome.
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Affiliation(s)
- Ki Hyeong Lee
- Comprehensive Epilepsy Center, Advent Health for Children, Orlando, FL, USA
| | - Yun-Jin Lee
- Comprehensive Epilepsy Center, Advent Health for Children, Orlando, FL, USA.,Department of Pediatrics, Pusan University College of Medicine, Yangsan, Korea
| | - Joo Hee Seo
- Comprehensive Epilepsy Center, Advent Health for Children, Orlando, FL, USA
| | | | - Michael Westerveld
- Comprehensive Epilepsy Center, Advent Health for Children, Orlando, FL, USA
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223
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Tomlinson SB, Buch VP, Armstrong D, Kennedy BC. Stereoelectroencephalography in Pediatric Epilepsy Surgery. J Korean Neurosurg Soc 2019; 62:302-312. [PMID: 31085956 PMCID: PMC6514312 DOI: 10.3340/jkns.2019.0015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 12/25/2022] Open
Abstract
Stereoelectroencephalography (SEEG) is an invasive technique used during the surgical management of medically refractory epilepsy. The utility of SEEG rests in its ability to survey the three-dimensional organization of the epileptogenic zone as well as nearby eloquent cortices. Once concentrated to specialized centers in Europe and Canada, the SEEG methodology has gained worldwide popularity due to its favorable morbidity profile, superior coverage of deep structures, and ability to perform multilobar explorations without the need for craniotomy. This rapid shift in practice represents both a challenge and an opportunity for pediatric neurosurgeons familiar with the subdural grid approach. The purpose of this review is to discuss the indications, technique, and safety of long-term SEEG monitoring in children. In addition to reviewing the conceptual and technical points of the diagnostic evaluation, attention will also be given to SEEG-based interventions (e.g., radiofrequency thermo-coagulation).
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Affiliation(s)
- Samuel B Tomlinson
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Vivek P Buch
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Dallas Armstrong
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin C Kennedy
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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224
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Zhu G, Chen Y, Du T, Liu D, Zhang X, Liu Y, Yuan T, Shi L, Zhang J. The Accuracy and Feasibility of Robotic Assisted Lead Implantation in Nonhuman Primates. Neuromodulation 2019; 22:441-450. [DOI: 10.1111/ner.12951] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/14/2019] [Accepted: 02/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Guan‐Yu Zhu
- Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University Beijing China
| | - Ying‐Chuan Chen
- Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University Beijing China
| | - Ting‐Ting Du
- Department of Functional Neurosurgery Beijing Neurosurgical Institute, Capital Medical University Beijing China
| | - De‐Feng Liu
- Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University Beijing China
| | - Xin Zhang
- Department of Functional Neurosurgery Beijing Neurosurgical Institute, Capital Medical University Beijing China
| | - Yu‐Ye Liu
- Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University Beijing China
| | - Tian‐Shuo Yuan
- Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University Beijing China
| | - Lin Shi
- Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University Beijing China
| | - Jian‐Guo Zhang
- Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University Beijing China
- Department of Functional Neurosurgery Beijing Neurosurgical Institute, Capital Medical University Beijing China
- Beijing Key Laboratory of Neurostimulation Beijing China
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225
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Issa Roach AT, Pizarro D, Deshpande HD, Pati S, Szaflarski JP, Riley KO, Muhlhofer W, Houston T. Ictogenesis during sEEG evaluation after acute intracranial hemorrhage. EPILEPSY & BEHAVIOR CASE REPORTS 2019; 11:115-119. [PMID: 30963027 PMCID: PMC6434162 DOI: 10.1016/j.ebcr.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/12/2019] [Accepted: 02/26/2019] [Indexed: 11/09/2022]
Abstract
We present a unique case of a patient with drug-resistant focal epilepsy undergoing stereoelectroencephalography (sEEG) who developed an acute posttraumatic intracranial hemorrhage during monitoring, first detected by changes on sEEG. Our case demonstrates the evolution of electrographic changes at the time of initial hemorrhage to the development of ictal activity. We conducted spectral analysis of the sEEG data to illustrate the transition from an interictal to ictal state. Initially, delta power increased in the region of acute hemorrhage, followed by sustained regional reduction in frequency variability. Our findings provide further information on the development of epileptiform activity in acute hemorrhage. sEEG shows new epileptiform activity in acute hemorrhage despite lack of clinical signs. In acute hemorrhage, there is initially an increase in delta power. There is loss of frequency variability in involved channels in acute hemorrhage.
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Affiliation(s)
- Alexandra T Issa Roach
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Diana Pizarro
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Hrishikesh D Deshpande
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Kristen O Riley
- Department of Neurosurgery, University of Alabama at Birmingham, AL, United States of America
| | - Wolfgang Muhlhofer
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Thomas Houston
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
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226
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Bourdillon P, Rheims S, Isnard J, Guénot M. Letter to the Editor. Temporal lobe epilepsy: open or stereotactic surgery? J Neurosurg 2019; 131:989. [PMID: 30797194 DOI: 10.3171/2018.11.jns183107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Pierre Bourdillon
- 1Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,2University of Lyon, Faculty of Medicine Claude Bernard, Lyon, France.,3Sorbonne University, Paris, France.,4Brain and Spine Institute, INSERM U1127, CNRS, UMR7225, Paris, France
| | - Sylvain Rheims
- 1Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,2University of Lyon, Faculty of Medicine Claude Bernard, Lyon, France.,5TIGER, Neuroscience Research Center of Lyon, INSERM U1028, CNRS 5292 Lyon, France; and
| | - Jean Isnard
- 1Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Marc Guénot
- 1Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,2University of Lyon, Faculty of Medicine Claude Bernard, Lyon, France.,6NEUROPAIN Team, Lyon Neuroscience Research Center, INSERM U1028, CNRS 5292, Lyon, France
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227
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McGovern RA, Ruggieri P, Bulacio J, Najm I, Bingaman WE, Gonzalez-Martinez JA. Risk analysis of hemorrhage in stereo-electroencephalography procedures. Epilepsia 2019; 60:571-580. [PMID: 30746685 DOI: 10.1111/epi.14668] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/18/2018] [Accepted: 01/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the true incidence of hemorrhage related to stereo-electroencephalography (SEEG) procedures. To analyze risk factors associated with the presence of different types of hemorrhage in SEEG procedures. METHODS This was a retrospective, single-center observational study examining every SEEG implantation performed at our center from 2009 to 2017. This consisted of 549 consecutive SEEG implantations using a variety of stereotactic and imaging techniques. A hemorrhage grading system was applied by a blinded neuroradiologist to every postimplant and postexplant computed tomography (CT) scan. Hemorrhages were classified as asymptomatic or symptomatic based on neurologic deficit seen on examination. Statistical analysis included multivariate regression using relevant preoperative variables to predict the presence of hemorrhage. RESULTS One hundred five implantations (19.1%) had any type of hemorrhage seen on postimplant CT. Of these, 93 (16.9%) were asymptomatic and 12 (2.2%) were symptomatic, with 3 implantations (0.6%) resulting in either a permanent deficit (2, 0.4%) or death (1, 0.2%). Male sex, increased number of electrodes, and increasing age were associated with increased risk of postimplant hemorrhage on multivariate analysis. Increasing score in the grading system was related to a statistically significant increase in the likelihood of a symptomatic hemorrhage. SIGNIFICANCE Detailed examination of every postimplant CT reveals that the total hemorrhage rate appears higher than previously reported. Most of these hemorrhages are small and asymptomatic. Our grading system may be useful to risk stratify these hemorrhages and awaits prospective validation.
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Affiliation(s)
- Robert A McGovern
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | - Paul Ruggieri
- Department of Neuroradiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Juan Bulacio
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Imad Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - William E Bingaman
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Spyrantis A, Cattani A, Woebbecke T, Konczalla J, Strzelczyk A, Rosenow F, Wagner M, Seifert V, Kudernatsch M, Freiman TM. Electrode placement accuracy in robot-assisted epilepsy surgery: A comparison of different referencing techniques including frame-based CT versus facial laser scan based on CT or MRI. Epilepsy Behav 2019; 91:38-47. [PMID: 30497893 DOI: 10.1016/j.yebeh.2018.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/16/2018] [Accepted: 11/01/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Precise robotic or stereotactic implantation of stereoelectroencephalography (sEEG) electrodes relies on the exact referencing of the planning images in order to match the patient's anatomy to the stereotactic device or robot. We compared the accuracy of sEEG electrode implantation with stereotactic frame versus laser scanning of the face based on computed tomography (CT) or magnetic resonance imaging (MRI) datasets for referencing. METHODS The accuracy was determined by calculating the Euclidian distance between the planned trajectory and the postoperative position of the sEEG electrode, defining the entry point error (EPE) and the target point error (TPE). The sEEG electrodes (n = 171) were implanted with the robotic surgery assistant (ROSA) in 19 patients. Preoperative trajectory planning was performed on three-dimensional (3D) MRI datasets. Referencing was accomplished either by performing (A) 1.25-mm slice CT with the patient's head fixed in a Leksell stereotactic frame (CT-frame, n = 49), fused with a 3D-T1-weighted, contrast enhanced- and T2-weighted 1.5 Tesla (T) MRI; (B) 1.25 mm CT (CT-laser, n = 60), fused with 3D-3.0-T MRI; (C) 3.0-T MRI T1-based laser scan (3.0-T MRI-laser, n = 56) or (D) in one single patient, because of a pacemaker, 3D-1.5-T MRI T1-based laser scan (1.5-T MRI-laser, n = 6). RESULTS In (A) CT-frame referencing, the mean EPE amounted to 0.86 mm and the mean TPE amounted to 2.28 mm (n = 49). In (B) CT-laser referencing, the EPE amounted to 1.85 mm and the TPE to 2.41 mm (n = 60). In (C) 3.0-T MRI-laser referencing, the mean EPE amounted to 3.02 mm and the mean TPE to 3.51 mm (n = 56). In (D) 1.5-T MRI, surprisingly the mean EPE amounted only to 0.97 mm and the TPE to 1.71 mm (n = 6). In 3 cases using CT-laser and 1 case using 3.0 T MRI-laser for referencing, small asymptomatic intracerebral hemorrhages were detected. No further complications were observed. CONCLUSION Robot-guided sEEG electrode implantation using CT-frame referencing and CT-laser-based referencing is most accurate and can serve for high precision placement of electrodes. In contrast, 3.0-T MRI-laser-based referencing is less accurate, but saves radiation. Most trajectories can be reached if alternative routes over less vascularized brain areas are used. This article is part of the Special Issue "Individualized Epilepsy Management: Medicines, Surgery and Beyond".
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Affiliation(s)
- Andrea Spyrantis
- Department of Neurosurgery, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany.
| | - Adriano Cattani
- Department of Neurosurgery, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany
| | - Tirza Woebbecke
- Department of Neurosurgery, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany
| | - Jürgen Konczalla
- Department of Neurosurgery, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Marlies Wagner
- Department of Neuroradiology, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany
| | | | - Thomas M Freiman
- Department of Neurosurgery, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
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Willems LM, Reif PS, Spyrantis A, Cattani A, Freiman TM, Seifert V, Wagner M, You SJ, Schubert-Bast S, Bauer S, Klein KM, Rosenow F, Strzelczyk A. Invasive EEG-electrodes in presurgical evaluation of epilepsies: Systematic analysis of implantation-, video-EEG-monitoring- and explantation-related complications, and review of literature. Epilepsy Behav 2019; 91:30-37. [PMID: 29907526 DOI: 10.1016/j.yebeh.2018.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stereoelectroencephalography (sEEG) is a diagnostic procedure for patients with refractory focal epilepsies that is performed to localize and define the epileptogenic zone. In contrast to grid electrodes, sEEG electrodes are implanted using minimal invasive operation techniques without large craniotomies. Previous studies provided good evidence that sEEG implantation is a safe and effective procedure; however, complications in asymptomatic patients after explantation may be underreported. The aim of this analysis was to systematically analyze clinical and imaging data following implantation and explantation. RESULTS We analyzed 18 consecutive patients (mean age: 30.5 years, range: 12-46; 61% female) undergoing invasive presurgical video-EEG monitoring via sEEG electrodes (n = 167 implanted electrodes) over a period of 2.5 years with robot-assisted implantation. There were no neurological deficits reported after implantation or explantation in any of the enrolled patients. Postimplantation imaging showed a minimal subclinical subarachnoid hemorrhage in one patient and further workup revealed a previously unknown factor VII deficiency. No injuries or status epilepticus occurred during video-EEG monitoring. In one patient, a seizure-related asymptomatic cross break of two fixation screws was found and led to revision surgery. Unspecific symptoms like headaches or low-grade fever were present in 10 of 18 (56%) patients during the first days of video-EEG monitoring and were transient. Postexplantation imaging showed asymptomatic and small bleedings close to four electrodes (2.8%). CONCLUSION Overall, sEEG is a safe and well-tolerated procedure. Systematic imaging after implantation and explantation helps to identify clinically silent complications of sEEG. In the literature, complication rates of up to 4.4% in sEEG and in 49.9% of subdural EEG are reported; however, systematic imaging after explantation was not performed throughout the studies, which may have led to underreporting of associated complications.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany.
| | - Philipp S Reif
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Andrea Spyrantis
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Adriano Cattani
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Marlies Wagner
- Department of Neuroradiology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Se-Jong You
- Department of Neuroradiology, Goethe-University, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Karl Martin Klein
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
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Vakani R, Nair DR. Electrocorticography and functional mapping. HANDBOOK OF CLINICAL NEUROLOGY 2019; 160:313-327. [DOI: 10.1016/b978-0-444-64032-1.00020-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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231
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Youngerman BE, Khan FA, McKhann GM. Stereoelectroencephalography in epilepsy, cognitive neurophysiology, and psychiatric disease: safety, efficacy, and place in therapy. Neuropsychiatr Dis Treat 2019; 15:1701-1716. [PMID: 31303757 PMCID: PMC6610288 DOI: 10.2147/ndt.s177804] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/22/2019] [Indexed: 12/14/2022] Open
Abstract
For patients with drug-resistant epilepsy, surgical intervention may be an effective treatment option if the epileptogenic zone (EZ) can be well localized. Subdural strip and grid electrode (SDE) implantations have long been used as the mainstay of intracranial seizure localization in the United States. Stereoelectroencephalography (SEEG) is an alternative approach in which depth electrodes are placed through percutaneous drill holes to stereotactically defined coordinates in the brain. Long used in certain centers in Europe, SEEG is gaining wider popularity in North America, bolstered by the advent of stereotactic robotic assistance and mounting evidence of safety, without the need for catheter-based angiography. Rates of clinically significant hemorrhage, infection, and other complications appear lower with SEEG than with SDE implants. SEEG also avoids unnecessary craniotomies when seizures are localized to unresectable eloquent cortex, found to be multifocal or nonfocal, or ultimately treated with stereotactic procedures such as laser interstitial thermal therapy (LITT), radiofrequency thermocoagulation (RF-TC), responsive neurostimulation (RNS), or deep brain stimulation (DBS). While SDE allows for excellent localization and functional mapping on the cortical surface, SEEG offers a less invasive option for sampling disparate brain areas, bilateral investigations, and deep or medial targets. SEEG has shown efficacy for seizure localization in the temporal lobe, the insula, lesional and nonlesional extra-temporal epilepsy, hypothalamic hamartomas, periventricular nodular heterotopias, and patients who have had prior craniotomies for resections or grids. SEEG offers a valuable opportunity for cognitive neurophysiology research and may have an important role in the study of dysfunctional networks in psychiatric disease and understanding the effects of neuromodulation.
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Affiliation(s)
- Brett E Youngerman
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Farhan A Khan
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
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232
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Chauvel P, Gonzalez-Martinez J, Bulacio J. Presurgical intracranial investigations in epilepsy surgery. HANDBOOK OF CLINICAL NEUROLOGY 2019; 161:45-71. [PMID: 31307620 DOI: 10.1016/b978-0-444-64142-7.00040-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Identification and localization of the "epileptogenic process" in the brain of patients with drug-resistant epilepsy for surgical cure is the goal of presurgical investigations. Intracranial recordings are required when conflicting data between seizure clinical semiology and EEG prevent precise localization within one hemisphere or lateralization, when a visible lesion on MRI seems unrelated to the electroclinical data, or in MRI-negative cases. Two methods are currently used. The objective of the subdural grid electrocorticography with or without depth electrodes (SDG/DE) is the best possible identification of the area of onset of spontaneous seizures and localization of the eloquent cortex. The objective of stereoelectroencephalography (SEEG) is to define the epileptogenic zone (configured as a network) and its relation to an unmasked lesion. Two-dimensional (SDG) and three-dimensional (SEEG) brain sampling dictate different strategies for noninvasive presurgical phase I goals as well as for data analysis. SEEG must resolve several potential localization hypotheses in a manner that cannot be achieved with SDG. SDG operates through brain surface coverage, unlike SEEG, which samples networks. SDG estimates the extent of cortical resection through a lobar or sublobar localization of ictal onset and constraints from functional mapping. SEEG defines a tailored resection according to the results of anatomo-electro-clinical correlations in stereotaxic space that will guide the ablation of the epileptogenic zone. SEEG is currently expanding faster than SDG. The prerequisites (especially in the preimplantation hypothetical strategy) and technical tools (especially stimulation and functional mapping) in the two methods are very different. This chapter presents a comparative review of the rationale, indications, electrode implantation strategies, interpretation, and surgical decision making of these two approaches of presurgical evaluation for epilepsy surgery.
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Affiliation(s)
- Patrick Chauvel
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
| | | | - Juan Bulacio
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
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Katz JS, Abel TJ. Stereoelectroencephalography Versus Subdural Electrodes for Localization of the Epileptogenic Zone: What Is the Evidence? Neurotherapeutics 2019; 16:59-66. [PMID: 30652253 PMCID: PMC6361059 DOI: 10.1007/s13311-018-00703-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Accurate and safe localization of epileptic foci is the crux of surgical therapy for focal epilepsy. As an initial evaluation, patients with drug-resistant epilepsy often undergo evaluation by noninvasive methods to identify the epileptic focus (i.e., the epileptogenic zone (EZ)). When there is incongruence of noninvasive neuroimaging, electroencephalographic, and clinical data, direct intracranial recordings of the brain are often necessary to delineate the EZ and determine the best course of treatment. Stereoelectroencephalography (SEEG) and subdural electrodes (SDEs) are the 2 most common methods for recording directly from the cortex to delineate the EZ. For the past several decades, SEEG and SDEs have been used almost exclusively in specific geographic regions (i.e., France and Italy for stereo-EEG and elsewhere for SDEs) for virtually the same indications. In the last decade, however, stereo-EEG has started to spread from select centers in Europe to many locations worldwide. Nevertheless, it is still not the preferred method for invasive localization of the EZ at many centers that continue to employ SDEs exclusively. Despite the increased dissemination of the SEEG method throughout the globe, important questions remain unanswered. Which method (SEEG or SDEs) is superior for identification of the EZ and does it depend on the etiology of epilepsy? Which technique is safer and does this hold for all patient populations? Should these 2 methods have equivalent indications or be used selectively for different focal epilepsies? In this review, we seek to address these questions using current invasive monitoring literature. Available meta-analyses of observational data suggest that SEEG is safer than SDEs, but it is less clear from available data which method is more accurate at delineating the EZ.
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Affiliation(s)
- Joel S Katz
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, 15238, USA
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, 15238, USA.
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, USA.
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Bourdillon P, Châtillon CE, Moles A, Rheims S, Catenoix H, Montavont A, Ostrowsky-Coste K, Boulogne S, Isnard J, Guénot M. Effective accuracy of stereoelectroencephalography: robotic 3D versus Talairach orthogonal approaches. J Neurosurg 2018; 131:1938-1946. [PMID: 30544338 DOI: 10.3171/2018.7.jns181164] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) was first developed in the 1950s by Jean Talairach using 2D angiography and a frame-based, orthogonal approach through a metallic grid. Since then, various other frame-based and frameless techniques have been described. In this study the authors sought to compare the traditional orthogonal Talairach 2D angiographic approach with a frame-based 3D robotic procedure that included 3D angiographic interoperative imaging guidance. MRI was used for both procedures during surgery, but MRI preplanning was done only in the robotic 3D technique. METHODS All study patients suffered from drug-resistant focal epilepsy and were treated at the same center by the same neurosurgical team. Fifty patients who underwent the 3D robotic procedure were compared to the same number of historical controls who had previously been successfully treated with the Talairach orthogonal procedure. The effectiveness and absolute accuracy, as well as safety, of the two procedures were compared. Moreover, in the 3D robotic group, the reliability of the preoperative MRI to avoid vascular structures was evaluated by studying the rate of trajectory modification following the coregistration of the intraoperative 3D angiographic data onto the preoperative MRI-based trajectory plans. RESULTS Effective accuracy (96.5% vs 13.7%) and absolute accuracy (1.15 mm vs 4.00 mm) were significantly higher in the 3D robotic group than in the Talairach orthogonal group. Both procedures showed excellent safety results (no major complications). The rate of electrode modification after 3D angiography was 43.8%, and it was highest for frontal and insular locations. CONCLUSIONS The frame-based, 3D angiographic, robotic procedure described here provided better accuracy for SEEG implantations than the traditional Talairach approach. This study also highlights the potential safety advantage of trajectory planning using intraoperative frame-based 3D angiography over preoperative MRI alone.
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Affiliation(s)
- Pierre Bourdillon
- 1Department of Neurosurgery, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- 2Faculty of Medicine Claude Bernard, University of Lyon, Lyon, France
- 3Faculty of Science & Engineering, Sorbonne University, Paris, France
- 4Brain and Spine Institute, INSERM U1127, CNRS 7225, Paris, France
| | - Claude-Edouard Châtillon
- 5Department of Surgery, Service of Neurosurgery, Centre Hospitalier Affilié Universitaire Régional, Trois-Rivières Hospital, Trois-Rivières, Quebec, Canada
- 6Faculty of Medicine, Division of Neurosurgery, Université de Montréal, Montreal, Quebec, Canada
| | - Alexis Moles
- 1Department of Neurosurgery, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Sylvain Rheims
- 2Faculty of Medicine Claude Bernard, University of Lyon, Lyon, France
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- 8TIGER, Neuroscience Research Center of Lyon, INSERM U1028, CNRS 5292, Université de Lyon, Lyon, France; and
| | - Hélène Catenoix
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Alexandra Montavont
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Karine Ostrowsky-Coste
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Sebastien Boulogne
- 2Faculty of Medicine Claude Bernard, University of Lyon, Lyon, France
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Jean Isnard
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Marc Guénot
- 1Department of Neurosurgery, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- 2Faculty of Medicine Claude Bernard, University of Lyon, Lyon, France
- 9NEUROPAIN Team, Lyon Neuroscience Research Center, INSERM U1028, CNRS 5292, Université de Lyon, Lyon, France
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Tsougos I, Kousi E, Georgoulias P, Kapsalaki E, Fountas KN. Neuroimaging methods in Epilepsy of Temporal Origin. Curr Med Imaging 2018; 15:39-51. [DOI: 10.2174/1573405613666170622114920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/04/2017] [Accepted: 05/11/2017] [Indexed: 11/22/2022]
Abstract
Background:
Temporal Lobe Epilepsy (TLE) comprises the most common form of
symptomatic refractory focal epilepsy in adults. Accurate lateralization and localization of the
epileptogenic focus are a significant prerequisite for determining surgical candidacy once the
patient has been deemed medically intractable. Structural MR imaging, clinical,
electrophysiological, and neurophysiological data have an established role in the localization of the
epileptogenic foci. Nevertheless, hippocampal sclerosis cannot be detected on MR images in more
than 30% of patients with TLE, and the presurgical assessment remains controversial.
</P><P>
Discussion: In the last years, advanced MR imaging techniques, such as 1H-MRS, DWI, DTI,
DSCI, and fMRI, may provide valuable additional information regarding the physiological and
metabolic characterization of brain tissue. MR imaging has shifted towards functional and
molecular imaging, thus, promising to improve the accuracy regarding the lateralization and the
localization of the epileptogenic focus. Additionally, nuclear medicine studies, such as SPECT and
PET imaging modalities, have become an asset for the decoding of brain function and activity, and
can be diagnostically helpful as well, since they provide valuable data regarding the altered
metabolic activity of the seizure foci.
Conclusion:
Overall, advanced MRI, SPECT, and PET imaging techniques are increasingly
becoming an essential part of TLE diagnostics, when the epileptogenic area is not identified on
structural MRI or when structural MRI, clinical, and electrophysiological findings are not in
concordance.
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Affiliation(s)
- Ioannis Tsougos
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
| | - Evanthia Kousi
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Panagiotis Georgoulias
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
| | - Eftychia Kapsalaki
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
| | - Kostas N. Fountas
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
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Candela-Cantó S, Aparicio J, López JM, Baños-Carrasco P, Ramírez-Camacho A, Climent A, Alamar M, Jou C, Rumià J, San Antonio-Arce V, Arzimanoglou A, Ferrer E. Frameless robot-assisted stereoelectroencephalography for refractory epilepsy in pediatric patients: accuracy, usefulness, and technical issues. Acta Neurochir (Wien) 2018; 160:2489-2500. [PMID: 30413938 DOI: 10.1007/s00701-018-3720-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/27/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stereoelectroencephalography (SEEG) is an effective technique to help to locate and to delimit the epileptogenic area and/or to define relationships with functional cortical areas. We intend to describe the surgical technique and verify the accuracy, safety, and effectiveness of robot-assisted SEEG in a newly created SEEG program in a pediatric center. We focus on the technical difficulties encountered at the early stages of this program. METHODS We prospectively collected SEEG indication, intraoperative events, accuracy calculated by fusion of postoperative CT with preoperative planning, complications, and usefulness of SEEG in terms of answering preimplantation hypothesis. RESULTS Fourteen patients between the ages of 5 and 18 years old (mean 10 years) with drug-resistant epilepsy were operated on between April 2016 and April 2018. One hundred sixty-four electrodes were implanted in total. The median entry point localization error (EPLE) was 1.57 mm (1-2.25 mm) and the median target point localization error (TPLE) was 1.77 mm (1.2-2.6 mm). We recorded seven intraoperative technical issues. Two patients suffered complications: meningitis without demonstrated germ in one patient and a right frontal hematoma in the other. In all cases, the SEEG was useful for the therapeutic decision-making. CONCLUSION SEEG has been useful for decision-making in all our pediatric patients. The robotic arm is an accurate tool for the insertion of the deep electrodes. Nevertheless, it is an invasive technique not risk-free and many problems can appear at the beginning of a robotic arm-assisted SEEG program that must be taken into account beforehand.
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Affiliation(s)
- Santiago Candela-Cantó
- Pediatric Neurosurgery Department, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain.
- Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain.
| | - Javier Aparicio
- Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain
| | - Jordi Muchart López
- Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain
- Diagnostic Imaging Department, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Baños-Carrasco
- Pediatric Neurosurgery Department, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
- Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain
| | - Alia Ramírez-Camacho
- Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain
| | - Alejandra Climent
- Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain
| | - Mariana Alamar
- Pediatric Neurosurgery Department, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
- Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain
| | - Cristina Jou
- Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain
- Pathology Department, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Rumià
- Pediatric Neurosurgery Department, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
- Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain
- Neurosurgery Department, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Alexis Arzimanoglou
- Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain
- Pediatric Epilepsy, Sleep and Neurophisiology Department, Centre Hospitalier Universitaire de Lyon and Hospital Femme-Mère-Enfant, Lyon, France
| | - Enrique Ferrer
- Pediatric Neurosurgery Department, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
- Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain
- Neurosurgery Department, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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237
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Ho AL, Muftuoglu Y, Pendharkar AV, Sussman ES, Porter BE, Halpern CH, Grant GA. Robot-guided pediatric stereoelectroencephalography: single-institution experience. J Neurosurg Pediatr 2018; 22:1-8. [PMID: 30117789 DOI: 10.3171/2018.5.peds17718] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 05/10/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEStereoelectroencephalography (SEEG) has increased in popularity for localization of epileptogenic zones in drug-resistant epilepsy because safety, accuracy, and efficacy have been well established in both adult and pediatric populations. Development of robot-guidance technology has greatly enhanced the efficiency of this procedure, without sacrificing safety or precision. To date there have been very limited reports of the use of this new technology in children. The authors present their initial experience using the ROSA platform for robot-guided SEEG in a pediatric population.METHODSBetween February 2016 and October 2017, 20 consecutive patients underwent robot-guided SEEG with the ROSA robotic guidance platform as part of ongoing seizure localization and workup for medically refractory epilepsy of several different etiologies. Medical and surgical history, imaging and trajectory plans, as well as operative records were analyzed retrospectively for surgical accuracy, efficiency, safety, and epilepsy outcomes.RESULTSA total of 222 leads were placed in 20 patients, with an average of 11.1 leads per patient. The mean total case time (± SD) was 297.95 (± 52.96) minutes and the mean operating time per lead was 10.98 minutes/lead, with improvements in total (33.36 minutes/lead vs 21.76 minutes/lead) and operative (13.84 minutes/lead vs 7.06 minutes/lead) case times/lead over the course of the study. The mean radial error was 1.75 (± 0.94 mm). Clinically useful data were obtained from SEEG in 95% of cases, and epilepsy surgery was indicated and performed in 95% of patients. In patients who underwent definitive epilepsy surgery with at least a 3-month follow-up, 50% achieved an Engel class I result (seizure freedom). There were no postoperative complications associated with SEEG placement and monitoring.CONCLUSIONSIn this study, the authors demonstrate that rapid adoption of robot-guided SEEG is possible even at a SEEG-naïve institution, with minimal learning curve. Use of robot guidance for SEEG can lead to significantly decreased operating times while maintaining safety, the overall goals of identification of epileptogenic zones, and improved epilepsy outcomes.
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Affiliation(s)
| | | | | | | | - Brenda E Porter
- 2Neurology, Stanford University School of Medicine, Stanford; and.,Divisions of3Pediatric Neurology and
| | | | - Gerald A Grant
- Departments of1Neurosurgery and.,4Pediatric Neurosurgery, Lucile Packard Children's Hospital Stanford, California
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238
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Sacino MF, Huang SS, Schreiber J, Gaillard WD, Oluigbo CO. Is the use of Stereotactic Electroencephalography Safe and Effective in Children? A Meta-Analysis of the use of Stereotactic Electroencephalography in Comparison to Subdural Grids for Invasive Epilepsy Monitoring in Pediatric Subjects. Neurosurgery 2018; 84:1190-1200. [DOI: 10.1093/neuros/nyy466] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 11/09/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Matthew F Sacino
- Department of Neurosurgery, Children's National Medical Center, George Washington University, Washington, District of Columbia
| | - Sean S Huang
- Department of Health Systems Administration, Georgetown University, Washington, District of Columbia
| | - John Schreiber
- Department of Neurology, Children's National Medical Center, George Washington University, Washington, District of Columbia
| | - William D Gaillard
- Department of Neurology, Children's National Medical Center, George Washington University, Washington, District of Columbia
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Medical Center, George Washington University, Washington, District of Columbia
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239
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Carlson AA, Rutishauser U, Mamelak AN. Safety and Utility of Hybrid Depth Electrodes for Seizure Localization and Single-Unit Neuronal Recording. Stereotact Funct Neurosurg 2018; 96:311-319. [PMID: 30326475 DOI: 10.1159/000493548] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Invasive electrode monitoring provides more precise localization of epileptogenic foci in patients with medically refractory epilepsy. The use of hybrid depth electrodes that include microwires for simultaneous single-neuron monitoring is becoming more widespread. OBJECTIVE To determine the safety and utility of hybrid depth electrodes for intracranial monitoring of medically refractory epilepsy. METHODS We reviewed the medical charts of 53 cases of medically refractory epilepsy operated on from 2006 to 2017, where both non-hybrid and hybrid microwire depth electrodes were used for intracranial monitoring. We assessed the localization accuracy and complications that arose to assess the relative safety and utility of hybrid depth electrodes compared with standard electrodes. RESULTS A total of 555 electrodes were implanted in 52 patients. The overall per-electrode complication rate was 2.3%, with a per-case complication rate of 20.8%. There were no infections or deaths. Serious or hemorrhagic complications occurred in 2 patients (0.4% per-electrode risk). Complications did not correlate with the use of any particular electrode type, and hybrids were equally as reliable as standard electrodes in localizing seizure onset zones. CONCLUSIONS Hybrid depth electrodes appear to be as safe and effective as standard depth electrodes for intracranial monitoring and provide unique opportunities to study the human brain at single-neuron resolution.
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Affiliation(s)
- April A Carlson
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California,
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240
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Englot DJ, Rolston JD. Memory decline from hippocampal electrodes? Let's not forget statistics and study design. Epilepsia 2018; 59:502-503. [PMID: 29411377 DOI: 10.1111/epi.13976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Dario J Englot
- Departments of Neurological Surgery, Radiology and Radiological Sciences, and Biomedical Engineering, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John D Rolston
- Departments of Neurosurgery and Bioengineering, University of Utah, Salt Lake City, UT, USA
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241
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Jones JC, Alomar S, McGovern RA, Firl D, Fitzgerald Z, Gale J, Gonzalez-Martinez JA. Techniques for placement of stereotactic electroencephalographic depth electrodes: Comparison of implantation and tracking accuracies in a cadaveric human study. Epilepsia 2018; 59:1667-1675. [PMID: 30142255 DOI: 10.1111/epi.14538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/17/2018] [Accepted: 07/20/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Stereotactic electroencephalography (SEEG) is used for the evaluation and identification of the epileptogenic zone (EZ) in patients suffering from medically refractory seizures and relies upon the accurate implantation of depth electrodes. Accurate implantation is critical for identification of the EZ. Multiple electrodes and implantation systems exist, but these have not previously been systematically evaluated for implantation accuracy. This study compares the accuracy of two SEEG electrode implantation methods. METHODS Thirteen "technique 1" electrodes (applying guiding bolts and external stylets) and 13 "technique 2" electrodes (without guiding bolts and external stylets) were implanted into four cadaver heads (52 total of each) according to each product's instructions for use using a stereotactic robot. Postimplantation computed tomography scans were compared to preimplantation computed tomography scans and to the previously defined targets. Electrode entry and final depth location were measured by Euclidean coordinates. The mean errors of each technique were compared using linear mixed effects models. RESULTS Primary analysis revealed that the mean error difference of the technique 1 and 2 electrodes at entry and target favored the technique 1 electrode implantation accuracy (P < 0.001). Secondary analysis demonstrated that orthogonal implantation trajectories were more accurate than oblique trajectories at entry for technique 1 electrodes (P = 0.002). Furthermore, deep implantations were significantly less accurate than shallow implantations for technique 2 electrodes (P = 0.005), but not for technique 1 electrodes (P = 0.50). SIGNIFICANCE Technique 1 displays greater accuracy following SEEG electrode implantation into human cadaver heads. Increased implantation accuracy may lead to increased success in identifying the EZ and increased seizure freedom rates following surgery.
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Affiliation(s)
- Jaes C Jones
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Soha Alomar
- Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.,Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio.,Division of Neurosurgery, Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Robert A McGovern
- Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.,Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Daniel Firl
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - John Gale
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jorge A Gonzalez-Martinez
- Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.,Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
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242
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Punia V, Bulacio J, Gonzalez-Martinez J, Abdelkader A, Bingaman W, Najm I, Stojic A. Extra operative intracranial EEG monitoring for epilepsy surgery in elderly patients. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:92-95. [PMID: 30112277 PMCID: PMC6092550 DOI: 10.1016/j.ebcr.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/14/2018] [Accepted: 07/06/2018] [Indexed: 06/08/2023]
Abstract
OBJECT The objective of the study is to investigate and report our experience with extra operative intracranial EEG monitoring for evaluation of epilepsy surgery among elderly (≥ 60 years) patients. METHODS After IRB approval, we searched our prospectively maintained epilepsy surgery database to find patients who underwent eiEEG at the age of 60 years or older. Electronic medical records were reviewed to extract clinical and surgery-related information. Patients who underwent resective epilepsy surgery after eiEEG and had at least 1 year of clinical follow-up were assessed for seizure outcome. Categorical and continuous variables were compared using Pearson chi-square and Student's t-test, respectively. RESULTS A total of 21 patients, with 13 (62%) women, underwent eiEEG in our center at the age of 60 years or older. The mean age at time of implantation was 63.8 ± 2.7 years. Sub-dural grids (SDG) were implanted in five (24%) patients, whereas sixteen (76%) patients underwent stereo-EEG (SEEG) implantation. Median number of contacts in SDG were 106 (56-136) and depth electrodes in SEEG were 12 (9-14). There were 2 complications, including one mortality due to intracerebral hemorrhage. Sixteen (76%) patients underwent respective epilepsy surgery after eiEEG and eleven (69%) achieved Engel class I outcome on the last follow-up [mean follow-up duration of 2.7 (± 1.8) years]. CONCLUSION We noticed an increased utilization of eiEEG in elderly patients after the introduction of SEEG at our center. Overall, we found that eiEEG can help achieve good seizure outcomes in the elderly population. However, the one eiEEG-related mortality serves a word of caution about the potential risks in this population.
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Affiliation(s)
- Vineet Punia
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
| | - Juan Bulacio
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
| | - Jorge Gonzalez-Martinez
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
| | - Ahmed Abdelkader
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
| | - William Bingaman
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
| | - Imad Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
| | - Andrey Stojic
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
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243
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Garcia-Lorenzo B, del Pino-Sedeño T, Rocamora R, López JE, Serrano-Aguilar P, Trujillo-Martín MM. Stereoelectroencephalography for Refractory Epileptic Patients Considered for Surgery: Systematic Review, Meta-Analysis, and Economic Evaluation. Neurosurgery 2018; 84:326-338. [DOI: 10.1093/neuros/nyy261] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 05/16/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Borja Garcia-Lorenzo
- Bordeaux Population Health, Team EMOS, Université de Bordeaux, Inserm U1219, Bordeaux, France
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Santa Cruz de Tenerife, Spain
- Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Tasmania del Pino-Sedeño
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Santa Cruz de Tenerife, Spain
- Departamento de Psicología Clínica, Psicobiología y Metodología, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Rodrigo Rocamora
- Epilepsy Unit, Department of Neurology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Juan Erviti López
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Servicio de Prestaciones Farmacéuticas, Dirección Atención Primaria, Servicio Navarro de Salud, Pamplona, Spain
| | - Pedro Serrano-Aguilar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Servicio de Evaluación y Planificación (SESCS), Servicio Canario de la Salud, Santa Cruz de Tenerife, Spain
| | - María M Trujillo-Martín
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Santa Cruz de Tenerife, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
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244
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Language mapping using electrocorticography versus stereoelectroencephalography: A case series. Epilepsy Behav 2018; 84:148-151. [PMID: 29803145 PMCID: PMC8252889 DOI: 10.1016/j.yebeh.2018.04.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 11/21/2022]
Abstract
Direct electrical stimulation (DES) is sometimes used in epilepsy surgery to identify areas that may result in language deficits if resected. Extraoperative language mapping is usually performed using electrocorticography (ECOG) - grids and strip electrodes; however, given the better safety profile of stereoelectroencephalogaphy (SEEG), it would be desirable to determine if mapping using SEEG is also effective. We report a case series of fifteen patients that underwent language mapping with either ECOG (5), SEEG (9), or both (1). Six patients in the SEEG group underwent resection or ablation with only mapping via SEEG. No patients in the SEEG group that underwent resective or ablative surgery experienced persistent language deficits. These results suggest that language mapping with SEEG may be considered as a clinically useful alternative to language mapping with ECOG.
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245
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Abel TJ, Varela Osorio R, Amorim-Leite R, Mathieu F, Kahane P, Minotti L, Hoffmann D, Chabardes S. Frameless robot-assisted stereoelectroencephalography in children: technical aspects and comparison with Talairach frame technique. J Neurosurg Pediatr 2018; 22:37-46. [PMID: 29676681 DOI: 10.3171/2018.1.peds17435] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Robot-assisted stereoelectroencephalography (SEEG) is gaining popularity as a technique for localization of the epileptogenic zone (EZ) in children with pharmacoresistant epilepsy. Here, the authors describe their frameless robot-assisted SEEG technique and report preliminary outcomes and relative complications in children as compared to results with the Talairach frame-based SEEG technique. METHODS The authors retrospectively analyzed the results of 19 robot-assisted SEEG electrode implantations in 17 consecutive children (age < 17 years) with pharmacoresistant epilepsy, and compared these results to 19 preceding SEEG electrode implantations in 18 children who underwent the traditional Talairach frame-based SEEG electrode implantation. The primary end points were seizure-freedom rates, operating time, and complication rates. RESULTS Seventeen children (age < 17 years) underwent a total of 19 robot-assisted SEEG electrode implantations. In total, 265 electrodes were implanted. Twelve children went on to have EZ resection: 4 demonstrated Engel class I outcomes, whereas 2 had Engel class II outcomes, and 6 had Engel class III-IV outcomes. Of the 5 patients who did not have resection, 2 underwent thermocoagulation. One child reported transient paresthesia associated with 2 small subdural hematomas, and 3 other children had minor asymptomatic intracranial hemorrhages. There were no differences in complication rates, rates of resective epilepsy surgery, or seizure freedom rates between this cohort and the preceding 18 children who underwent Talairach frame-based SEEG. The frameless robot-assisted technique was associated with shorter operating time (p < 0.05). CONCLUSIONS Frameless robot-assisted SEEG is a safe and effective means of identifying the EZ in children with pharmacoresistant partial epilepsy. Robot-assisted SEEG is faster than the Talairach frame-based method, and has equivalent safety and efficacy. The former, furthermore, facilitates more electrode trajectory possibilities, which may improve the localization of epileptic networks.
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Affiliation(s)
- Taylor J Abel
- 1Clinique de Neurochirurgie, and.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Ricardo Amorim-Leite
- 3Clinique Neurologique, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; and
| | - Francois Mathieu
- 2Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Philippe Kahane
- 3Clinique Neurologique, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; and
| | - Lorella Minotti
- 3Clinique Neurologique, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; and
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Abou-Al-Shaar H, Brock AA, Kundu B, Englot DJ, Rolston JD. Increased nationwide use of stereoencephalography for intracranial epilepsy electroencephalography recordings. J Clin Neurosci 2018; 53:132-134. [PMID: 29724650 PMCID: PMC6188665 DOI: 10.1016/j.jocn.2018.04.064] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/22/2018] [Indexed: 01/04/2023]
Abstract
Intracranial electroencephalography (iEEG) can be performed using minimally invasive stereo-electroencephalography (SEEG) or by implanting subdural electrodes via a craniotomy or multiple burr holes. There is anecdotal evidence that SEEG is becoming more common in the United States, though this has yet to be quantified. To address this question, all SEEG and burr hole/craniotomy subdural iEEG procedures were extracted from the Centers for Medicare and Medicaid Services Part B data files for the years 2000-2016. National trends were compared over time. In 2016, SEEG became the most frequently performed intracranial monitoring procedure in the Medicare population, increasing from 28.8% of total cases in 2000 to 43.1% in 2016 (p = 0.02). The proportion of strip electrode cases (through burr holes) significantly declined, while the frequency of craniotomies for subdural grid placement did not significantly change. These data are consistent with a nationwide increase in the utilization of SEEG with a concomitant decline in burr hole placement of subdural strip electrodes in the United States. The factors driving these changes are unknown, but are likely due in part to the desire for minimally invasive surgical options.
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Affiliation(s)
- Hussam Abou-Al-Shaar
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Andrea A Brock
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Bornali Kundu
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Dario J Englot
- Department of Neurosurgery, Vanderbilt University, Nashville, TN, United States
| | - John D Rolston
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States.
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247
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Witkowska-Wrobel A, Aristovich K, Faulkner M, Avery J, Holder D. Feasibility of imaging epileptic seizure onset with EIT and depth electrodes. Neuroimage 2018; 173:311-321. [DOI: 10.1016/j.neuroimage.2018.02.056] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 11/27/2022] Open
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248
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Meador KJ, Halpern CH, Hermann BP. Cognitive safety of intracranial electrodes for epilepsy. Epilepsia 2018; 59:1132-1137. [PMID: 29771452 DOI: 10.1111/epi.14197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 11/28/2022]
Abstract
Two recent articles in Epilepsia have raised concerns about adverse cognitive effects associated with intracranial electrode implantation. However, both studies have important limitations, and their results contrast with studies that report no adverse cognitive effects of intracranial electrodes for diagnosis or neurostimulation in epilepsy. Furthermore, no data are provided on the relative safety of depth electrodes implanted along the longitudinal axis of the hippocampus vs other electrode locations or types of electrodes. Instituting changes in the use of depth electrodes based solely on these 2 studies is not clinically indicated. Further research is needed.
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Affiliation(s)
- Kimford J Meador
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA, USA
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Vakharia VN, Sparks R, Rodionov R, Vos SB, Dorfer C, Miller J, Nilsson D, Tisdall M, Wolfsberger S, McEvoy A, Miserocchi A, Winston GP, O’Keeffe AG, Ourselin S, Duncan JS. Computer-assisted planning for the insertion of stereoelectroencephalography electrodes for the investigation of drug-resistant focal epilepsy: an external validation study. J Neurosurg 2018; 130:601-610. [PMID: 29652234 PMCID: PMC6076995 DOI: 10.3171/2017.10.jns171826] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/02/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE One-third of cases of focal epilepsy are drug refractory, and surgery might provide a cure. Seizure-free outcome after surgery depends on the correct identification and resection of the epileptogenic zone. In patients with no visible abnormality on MRI, or in cases in which presurgical evaluation yields discordant data, invasive stereoelectroencephalography (SEEG) recordings might be necessary. SEEG is a procedure in which multiple electrodes are placed stereotactically in key targets within the brain to record interictal and ictal electrophysiological activity. Correlating this activity with seizure semiology enables identification of the seizure-onset zone and key structures within the ictal network. The main risk related to electrode placement is hemorrhage, which occurs in 1% of patients who undergo the procedure. Planning safe electrode placement for SEEG requires meticulous adherence to the following: 1) maximize the distance from cerebral vasculature, 2) avoid crossing sulcal pial boundaries (sulci), 3) maximize gray matter sampling, 4) minimize electrode length, 5) drill at an angle orthogonal to the skull, and 6) avoid critical neurological structures. The authors provide a validation of surgical strategizing and planning with EpiNav, a multimodal platform that enables automated computer-assisted planning (CAP) for electrode placement with user-defined regions of interest. METHODS Thirteen consecutive patients who underwent implantation of a total 116 electrodes over a 15-month period were studied retrospectively. Models of the cortex, gray matter, and sulci were generated from patient-specific whole-brain parcellation, and vascular segmentation was performed on the basis of preoperative MR venography. Then, the multidisciplinary implantation strategy and precise trajectory planning were reconstructed using CAP and compared with the implemented manually determined plans. Paired results for safety metric comparisons were available for 104 electrodes. External validity of the suitability and safety of electrode entry points, trajectories, and target-point feasibility was sought from 5 independent, blinded experts from outside institutions. RESULTS CAP-generated electrode trajectories resulted in a statistically significant improvement in electrode length, drilling angle, gray matter-sampling ratio, minimum distance from segmented vasculature, and risk (p < 0.05). The blinded external raters had various opinions of trajectory feasibility that were not statistically significant, and they considered a mean of 69.4% of manually determined trajectories and 62.2% of CAP-generated trajectories feasible; 19.4% of the CAP-generated electrode-placement plans were deemed feasible when the manually determined plans were not, whereas 26.5% of the manually determined electrode-placement plans were rated feasible when CAP-determined plans were not (no significant difference). CONCLUSIONS CAP generates clinically feasible electrode-placement plans and results in statistically improved safety metrics. CAP is a useful tool for automating the placement of electrodes for SEEG; however, it requires the operating surgeon to review the results before implantation, because only 62% of electrode-placement plans were rated feasible, compared with 69% of the manually determined placement plans, mainly because of proximity of the electrodes to unsegmented vasculature. Improved vascular segmentation and sulcal modeling could lead to further improvements in the feasibility of CAP-generated trajectories.
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Affiliation(s)
- Vejay N. Vakharia
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom
- National Hospital for Neurology and Neurosurgery, Queen Square, London
| | - Rachel Sparks
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom
| | - Roman Rodionov
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom
- National Hospital for Neurology and Neurosurgery, Queen Square, London
| | - Sjoerd B. Vos
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom
- Transitional Imaging Group, Centre for Medical Image Computing, University College London
| | - Christian Dorfer
- Department of Neurosurgery, Medical University Vienna - General Hospital (AKH) Waehringer Guertel 18-20, Vienna, Austria
| | - Jonathan Miller
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Daniel Nilsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden
| | - Martin Tisdall
- Great Ormond Street Hospital, UCL Great Ormond Street Institute of Child Health
| | - Stefan Wolfsberger
- Department of Neurosurgery, Medical University Vienna - General Hospital (AKH) Waehringer Guertel 18-20, Vienna, Austria
| | - Andrew McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery
- National Hospital for Neurology and Neurosurgery, Queen Square, London
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom
- National Hospital for Neurology and Neurosurgery, Queen Square, London
| | | | - Sebastien Ourselin
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom
- National Hospital for Neurology and Neurosurgery, Queen Square, London
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Vakharia VN, Duncan JS, Witt JA, Elger CE, Staba R, Engel J. Getting the best outcomes from epilepsy surgery. Ann Neurol 2018. [PMID: 29534299 PMCID: PMC5947666 DOI: 10.1002/ana.25205] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurosurgery is an underutilized treatment that can potentially cure drug‐refractory epilepsy. Careful, multidisciplinary presurgical evaluation is vital for selecting patients and to ensure optimal outcomes. Advances in neuroimaging have improved diagnosis and guided surgical intervention. Invasive electroencephalography allows the evaluation of complex patients who would otherwise not be candidates for neurosurgery. We review the current state of the assessment and selection of patients and consider established and novel surgical procedures and associated outcome data. We aim to dispel myths that may inhibit physicians from referring and patients from considering neurosurgical intervention for drug‐refractory focal epilepsies. Ann Neurol 2018;83:676–690
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Affiliation(s)
- Vejay N Vakharia
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom, and Chalfont Centre for Epilepsy
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom, and Chalfont Centre for Epilepsy
| | - Juri-Alexander Witt
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Christian E Elger
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Richard Staba
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Jerome Engel
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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