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Gavvala JR. The United States Stereotactic EEG Survey: Current Practice and Future Opportunities. J Clin Neurophysiol 2024; 41:402-404. [PMID: 38935652 DOI: 10.1097/wnp.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
PURPOSE Stereotactic EEG (SEEG) is being increasingly used in the intracranial evaluation of refractory epilepsy in the United States. A 2022 survey of SEEG practices among National Association of Epilepsy Centers tertiary referral (NAEC level IV) centers found largely similar practices across institutions. However, a few significant differences were noted in technical and patient care practice, and in the level of SEEG background training. In the year since publication, we review the identified challenges facing SEEG practice and suggest specific corrective action. CONCLUSIONS Stereotactic EEG has rapidly become the principal method for intracranial EEG monitoring in epilepsy surgery centers in the United States. The rate of adoption of SEEG is currently higher than the growth of invasive monitoring overall. Most report similar indications for SEEG, although significant variability exists in personnel expertise and technical and patient care practice. Consensus statements, guidelines, and review of postgraduate training curricula are urgently needed to benchmark SEEG practice and develop appropriate skillsets in the next generation of practitioners in the United States.
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Affiliation(s)
- Jay R Gavvala
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
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Fujimoto A, Matsumaru Y, Masuda Y, Sato K, Hatano K, Numoto S, Hotta R, Marushima A, Hosoo H, Araki K, Okanishi T, Ishikawa E. Endovascular electroencephalography (eEEG) can detect the laterality of epileptogenic foci as accurately as subdural electrodes. Heliyon 2024; 10:e25567. [PMID: 38327423 PMCID: PMC10847992 DOI: 10.1016/j.heliyon.2024.e25567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/28/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
Background Traditional brain activity monitoring via scalp electroencephalography (EEG) offers limited resolution and is susceptible to artifacts. Endovascular electroencephalography (eEEG) emerged in the 1990s. Despite early successes and potential for detecting epileptiform activity, eEEG has remained clinically unutilized. This study aimed to further test the capabilities of eEEG in detecting lateralized epileptic discharges in animal models. We hypothesized that eEEG would be able to detect lateralization. The purpose of this study was to measure epileptiform discharges with eEEG in animal models with lateralization in epileptogenicity. Materials and methods We inserted eEEG electrodes into the transverse sinuses of three pigs, and subdural electrodes (SDs) on the surfaces of the left and right hemispheres. We induced epileptogenicity with penicillin in the left brain of pigs F00001 and F00003, and in the right brain of pig F00002. The resulting epileptiform discharges were measured by eEEG electrodes placed in the left and right transverse sinuses, and conducted comparisons with epileptiform discharges from SDs. We also had 12 neurological physicians interpret measurement results from eEEG alone and determine the side (left or right) of epileptogenicity. Results Three pigs were evaluated for epileptiform discharge detection using eEEG: F00001 (7 months old, 14.0 kg), F00002 (8 months old, 15.6 kg), and F00003 (8 months old, 14.4 kg). The eEEG readings were compared with results from SDs, showing significant alignment across all subjects (p < 0.001). The sensitivity and positive predictive values (PPV) were as follows: F00001 had 0.93 and 0.96, F00002 had 0.99 and 1.00, and F00003 had 0.98 and 0.99. Even though one of the neurological physicians got all sides incorrect, all other assessments were correct. Upon post-experimental dissection, no abnormalities were observed in the brain tissue or in the vascular damage at the site where the eEEG was placed, based on pathological evaluation. Conclusion With eEEG, lateralization can be determined with high sensitivity (>0.93) and PPV (>0.95) that appear equivalent to those of subdural EEG in the three pigs. This lateralization was also discernible by neurological physicians on visual inspection.
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Affiliation(s)
- Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
- Seirei Christopher University, Shizuoka, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- E.P. Medical Inc., Tokyo, Japan
| | - Yosuke Masuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Keisuke Hatano
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Shingo Numoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Ryuya Hotta
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hisayuki Hosoo
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kota Araki
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tohru Okanishi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Kaewborisutsakul A, Chernov M, Yokosako S, Kubota Y. Usefulness of Robotic Stereotactic Assistance (ROSA ®) Device for Stereoelectroencephalography Electrode Implantation: A Systematic Review and Meta-analysis. Neurol Med Chir (Tokyo) 2024; 64:71-86. [PMID: 38220166 PMCID: PMC10918457 DOI: 10.2176/jns-nmc.2023-0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/17/2023] [Indexed: 01/16/2024] Open
Abstract
The aim of this study was to systematically review and meta-analyze the efficiency and safety of using the Robotic Stereotactic Assistance (ROSA®) device (Zimmer Biomet; Warsaw, IN, USA) for stereoelectroencephalography (SEEG) electrode implantation in patients with drug-resistant epilepsy. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was carried out. Overall, 855 nonduplicate relevant articles were determined, and 15 of them were selected for analysis. The benefits of the ROSA® device use in terms of electrode placement accuracy, as well as operative time length, perioperative complications, and seizure outcomes, were evaluated. Studies that were included reported on a total of 11,257 SEEG electrode implantations. The limited number of comparative studies hindered the comprehensive evaluation of the electrode implantation accuracy. Compared with frame-based or navigation-assisted techniques, ROSA®-assisted SEEG electrode implantation provided significant benefits for reduction of both overall operative time (mean difference [MD], -63.45 min; 95% confidence interval [CI] from -88.73 to -38.17 min; P < 0.00001) and operative time per implanted electrode (MD, -8.79 min; 95% CI from -14.37 to -3.21 min; P = 0.002). No significant differences existed in perioperative complications and seizure outcomes after the application of the ROSA® device and other techniques for electrode implantation. To conclude, the available evidence shows that the ROSA® device is an effective and safe surgical tool for trajectory-guided SEEG electrode implantation in patients with drug-resistant epilepsy, offering benefits for saving operative time and neither increasing the risk of perioperative complications nor negatively impacting seizure outcomes.
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Affiliation(s)
- Anukoon Kaewborisutsakul
- Neurological Surgery Unit, Division of Surgery, Faculty of Medicine, Prince of Songkla University
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
| | - Mikhail Chernov
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
| | - Suguru Yokosako
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
| | - Yuichi Kubota
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
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Kagawa K, Iida K, Hashizume A, Seyama G, Okamura A, Askoro R, Horie N. Retained Intracerebral Depth Electrode after Stereotactic Electroencephalography Monitoring: A Case Report. NMC Case Rep J 2024; 11:49-53. [PMID: 38454914 PMCID: PMC10918211 DOI: 10.2176/jns-nmc.2023-0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/13/2023] [Indexed: 03/09/2024] Open
Abstract
Stereotactic electroencephalography (SEEG) is an increasingly popular surgical modality for localizing the epileptogenic zone. Robot-guided stereotactic electrode placement has been covered in Japan by National Health Insurance since 2020. However, several surgical devices, such as the anchor bolt (a thin, hollow, metal shaft that serves as a guide screw or fixing for each electrode), have not been approved. A 14-year-old female who underwent SEEG for intractable epilepsy and required additional surgery to remove a retained depth electrode from the skull after the SEEG monitoring was finished. She had uncontrolled focal seizures consisting of nausea and laryngeal constriction at the onset. After a comprehensive presurgical evaluation, robot-guided stereotactic electrode implantation was performed to evaluate her seizures by SEEG. Nine depth electrodes were implanted through the twist drill hole. The electrodes were sutured to her skin for fixation without anchor bolts. When we attempted to remove the electrodes after 8 days of SEEG monitoring, one of the electrodes was retained. The retained electrode was removed through an additional skin incision and a small craniectomy under general anesthesia. We confirmed narrowing of the twist drill hole pathway in the internal table of the skull due to osteogenesis, which locked the electrode. This complication might be avoided if an anchor bolt had been used. This case report prompts the approval of the anchor bolts to avoid difficulty in electrode removal. Moreover, approval of a depth electrode with a thinner diameter and more consistent hardness is needed.
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Affiliation(s)
- Kota Kagawa
- Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
- Epilepsy Center, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Koji Iida
- Epilepsy Center, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Akira Hashizume
- Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
- Epilepsy Center, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Go Seyama
- Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
- Epilepsy Center, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Akitake Okamura
- Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
- Epilepsy Center, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Rofat Askoro
- Epilepsy Center, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
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Murray-Douglass A, Papacostas J, Ovington A, Wensley I, Campbell R, Gillinder L. Stereoelectroencephalography: a review of complications and outcomes in a new Australian centre. Intern Med J 2024; 54:35-42. [PMID: 38165070 DOI: 10.1111/imj.16284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 11/01/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Surgical management of refractory focal epilepsy requires preoperative localisation of the epileptogenic zone (EZ). To augment noninvasive studies, stereoelectroencephalography (SEEG) is being increasingly adopted as a form of intracranial monitoring. AIMS This study aimed to determine the rate of complications for patients undergoing SEEG and to report the success of SEEG with regard to EZ detection and seizure outcome following definitive surgery. METHODS A retrospective cohort design investigated all cases of SEEG at our institution. Surgical, anaesthetic and medical complications with subsequent epilepsy surgery and seizure outcome data were extracted from medical records. Multivariate logistic regression was used to investigate the relationship between both the number of electrodes per patient and the duration of SEEG recording with the rate of complications. RESULTS Sixty-four patients with 66 implantations were included. Headache was the most common complication (n = 54, 82%). There were no major surgical or medical complications. Two anaesthetic complications occurred. EZ localisation was successful in 63 cases (95%). Curative intent surgery was performed in 39 patients (59%) and 23 patients achieved an Engel class I outcome (59% of those undergoing surgery). The number of electrodes and duration of recording were not associated with complications. CONCLUSIONS No patients in our series experienced major surgical or medical complications and we have highlighted the challenges associated with neuroanaesthesia in SEEG. Our complication rates and seizure outcomes are equivalent to published literature indicating that this technique can be successfully established in newer centres using careful case selection. Standardised reporting of SEEG complications should be adopted.
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Affiliation(s)
| | - Jason Papacostas
- Mater Neurosciences Centre, Mater Hospital, Brisbane, Queensland, Australia
| | - Anne Ovington
- Mater Neurosciences Centre, Mater Hospital, Brisbane, Queensland, Australia
| | - Isaac Wensley
- Mater Neurosciences Centre, Mater Hospital, Brisbane, Queensland, Australia
| | - Robert Campbell
- Mater Neurosciences Centre, Mater Hospital, Brisbane, Queensland, Australia
| | - Lisa Gillinder
- Mater Neurosciences Centre, Mater Hospital, Brisbane, Queensland, Australia
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Li L, Jiang C, Li L. A Comparative Study on the Effect of Substrate Structure on Electrochemical Performance and Stability of Electrodeposited Platinum and Iridium Oxide Coatings for Neural Electrodes. MICROMACHINES 2023; 15:70. [PMID: 38258189 PMCID: PMC10821385 DOI: 10.3390/mi15010070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Implantable electrodes are crucial for stimulation safety and recording quality of neuronal activity. To enhance their electrochemical performance, electrodeposited nanostructured platinum (nanoPt) and iridium oxide (IrOx) have been proposed due to their advantages of in situ deposition and ease of processing. However, their unstable adhesion has been a challenge in practical applications. This study investigated the electrochemical performance and stability of nanoPt and IrOx coatings on hierarchical platinum-iridium (Pt-Ir) substrates prepared by femtosecond laser, compared with the coatings on smooth Pt-Ir substrates. Ultrasonic testing, agarose gel testing, and cyclic voltammetry (CV) testing were used to evaluate the coatings' stability. Results showed that the hierarchical Pt-Ir substrate significantly enhanced the charge-storage capacity of electrodes with both coatings to more than 330 mC/cm2, which was over 75 times that of the smooth Pt-Ir electrode. The hierarchical substrate could also reduce the cracking of nanoPt coatings after ultrasonic, agarose gel and CV testing. Although some shedding was observed in the IrOx coating on the hierarchical substrate after one hour of sonication, it showed good stability in the agarose gel and CV tests. Stable nanoPt and IrOx coatings may not only improve the electrochemical performance but also benefit the function of neurobiochemical detection.
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Affiliation(s)
- Linze Li
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou 350108, China
| | - Changqing Jiang
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing 100084, China
| | - Luming Li
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing 100084, China
- IDG/McGovern Institute for Brain Research, Tsinghua University, Beijing 100084, China
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Uda T. Neuroimaging of Brain Tumor Surgery and Epilepsy. Brain Sci 2023; 13:1701. [PMID: 38137149 PMCID: PMC10742002 DOI: 10.3390/brainsci13121701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
To make the best clinical judgements, surgeons need to integrate information acquired via multimodal imaging [...].
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Affiliation(s)
- Takehiro Uda
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka City 545-8585, Osaka, Japan
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Cameron N, Fry L, Kabangu JL, Schatmeyer BA, Miller C, Ulloa CM, Uysal U, Cheng JJ, Kinsman MJ, Rouse AG, Landazuri P. Using pre-surgical suspicion to guide insula implantation strategy. Heliyon 2023; 9:e18284. [PMID: 37539155 PMCID: PMC10395527 DOI: 10.1016/j.heliyon.2023.e18284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023] Open
Abstract
Rationale Insular epilepsy can be a challenging diagnosis due to overlapping semiology and scalp EEG findings with frontal, temporal, and parietal lobe epilepsies. Stereotactic electroencephalography (sEEG) provides an opportunity to better localize seizure onset. The possibility of improved localization is balanced by implantation risk in this vascularly rich anatomic region. We review both safety and pre-implantation factors involved in insular electrode placement across four years at an academic medical center. Methods Presurgical data, operative reports, and invasive EEG summaries were retrospectively reviewed for patients undergoing invasive epilepsy monitoring on the insula from 2016 through 2019. EEG reports were reviewed to record the presence of insula ictal and interictal involvement. We recorded which presurgical findings suggested insular involvement (insula lesion on MRI, insula changes on PET/SPECT/scalp EEG, characteristic semiology, or history of failed anterior temporal lobectomy). The likelihood of pre-sEEG insular onset was categorized as low suspicion if no presurgical findings were present ("rule out"), moderate suspicion if one finding was present, and high suspicion if two or more findings were present. Results 76 patients received 189 insular electrodes as part of their implantation strategy for 79 surgical cases. Seven patients (8.9%) had insular ictal onset. One clinically significant complication (left hemiparesis) occurred in a patient with moderate suspicion for insular onset. There were 38 low suspicion cases, 36 moderate suspicion cases, and 5 high suspicion cases for pre-sEEG insula ictal onset. Two low suspicion (5.3%), three moderate suspicion (8.6%), and two high suspicion (40%) cases had insular ictal onset. Conclusions The insula can safely receive sEEG. Having two or more presurgical factors indicating insular onset is a strong, albeit incomplete, predictor of insular seizure onset. Using pre-implantation clinical findings can offer clinicians predictive value for targeting the insula during invasive EEG monitoring.
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Affiliation(s)
- Nathaniel Cameron
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Lane Fry
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Jean-Luc Kabangu
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | | | - Christopher Miller
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Carol M. Ulloa
- Dept. of Neurology, University of Kansas Medical Center, United States
| | - Utku Uysal
- Dept. of Neurology, University of Kansas Medical Center, United States
| | - Jennifer J. Cheng
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Michael J. Kinsman
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Adam G. Rouse
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
- Dept. of Cell Biology & Physiology, University of Kansas Medical Center, United States
- Dept. of Electrical Engineering and Computer Science, University of Kansas, United States
| | - Patrick Landazuri
- Dept. of Neurology, University of Kansas Medical Center, United States
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Yindeedej V, Uda T, Kawashima T, Koh S, Tanoue Y, Kojima Y, Goto T. Electrode Tip Shift During the Stereotactic Electroencephalography Evaluation Period with Boltless Suture Fixation. World Neurosurg 2023; 175:e1210-e1219. [PMID: 37427700 DOI: 10.1016/j.wneu.2023.04.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/24/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Electrodes for stereotactic electroencephalography (SEEG) are typically fixed to the skull with anchor bolts. When anchor bolts are unavailable, electrodes have to be fixed using other methods, carrying the possibility of electrode shift. This study, therefore, evaluated the characteristics of electrode tip shift during SEEG monitoring in patients with electrodes fixed using the suture technique. METHODS We retrospectively included patients who underwent SEEG implantation with suture fixation and evaluated the tip shift distance (TSD) of electrodes. Possible influences evaluated included: 1) implantation period, 2) lobe of entry, 3) unilateral or bilateral implantation, 4) electrode length, 5) skull thickness, and 6) scalp thickness difference. RESULTS A total of 50 electrodes in 7 patients were evaluated. TSD was 1.4 ± 2.0 mm (mean ± standard deviation). Implantation period was 8.1 ± 2.2 days. Entry lobe was frontal for 28 electrodes and temporal for 22 electrodes. Implantation was bilateral for 25 electrodes and unilateral for 25 electrodes. Electrode length was 45.4 ± 14.3 mm. Skull thickness was 6.0 ± 3.7 mm. Scalp thickness difference was -1.5 ± 2.1 mm, which was found greater in temporal lobe entry compared with frontal lobe entry. According to univariate analyses, neither implantation period nor electrode length correlated with TSD. Multivariate regression analysis showed that only greater scalp thickness difference correlated significantly with greater TSD (P = 0.0018). CONCLUSIONS Greater scalp thickness difference correlated with greater TSD. Surgeons need to consider the degree of scalp thickness difference and electrode shift when using suture fixation, especially with temporal lobe entry.
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Affiliation(s)
- Vich Yindeedej
- Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan; Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Takehiro Uda
- Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan.
| | - Toshiyuki Kawashima
- Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Saya Koh
- Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Yuta Tanoue
- Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Yuichiro Kojima
- Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Takeo Goto
- Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
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Anand A, Magnotti JF, Smith DN, Gadot R, Najera RA, Hegazy MIR, Gavvala JR, Shofty B, Sheth SA. Predictive value of magnetoencephalography in guiding the intracranial implant strategy for intractable epilepsy. J Neurosurg 2022; 137:1237-1247. [PMID: 35303696 DOI: 10.3171/2022.1.jns212943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Magnetoencephalography (MEG) is a useful component of the presurgical evaluation of patients with epilepsy. Due to its high spatiotemporal resolution, MEG often provides additional information to the clinician when forming hypotheses about the epileptogenic zone (EZ). Because of the increasing utilization of stereo-electroencephalography (sEEG), MEG clusters are used to guide sEEG electrode targeting with increasing frequency. However, there are no predefined features of an MEG cluster that predict ictal activity. This study aims to determine which MEG cluster characteristics are predictive of the EZ. METHODS The authors retrospectively analyzed all patients who had an MEG study (2017-2021) and underwent subsequent sEEG evaluation. MEG dipoles and sEEG electrodes were reconstructed in the same coordinate space to calculate overlap among individual contacts on electrodes and MEG clusters. MEG cluster features-including number of dipoles, proximity, angle, density, magnitude, confidence parameters, and brain region-were used to predict ictal activity in sEEG. Logistic regression was used to identify important cluster features and to train a binary classifier to predict ictal activity. RESULTS Across 40 included patients, 196 electrodes (42.2%) sampled MEG clusters. Electrodes that sampled MEG clusters had higher rates of ictal and interictal activity than those that did not sample MEG clusters (ictal 68.4% vs 39.8%, p < 0.001; interictal 71.9% vs 44.6%, p < 0.001). Logistic regression revealed that the number of dipoles (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.04-1.14, t = 3.43) and confidence volume (OR 0.02, 95% CI 0.00-0.86, t = -2.032) were predictive of ictal activity. This model was predictive of ictal activity with 77.3% accuracy (sensitivity = 80%, specificity = 74%, C-statistic = 0.81). Using only the number of dipoles had a predictive accuracy of 75%, whereas a threshold between 14 and 17 dipoles in a cluster detected ictal activity with 75.9%-85.2% sensitivity. CONCLUSIONS MEG clusters with approximately 14 or more dipoles are strong predictors of ictal activity and may be useful in the preoperative planning of sEEG implantation.
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Affiliation(s)
| | - John F Magnotti
- 2Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | - Jay R Gavvala
- 3Neurology, Baylor College of Medicine, Houston, Texas; and
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Philipp L, Miller C, Wu C. Letter: Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results. Oper Neurosurg (Hagerstown) 2022; 23:e216-e217. [PMID: 35972123 DOI: 10.1227/ons.0000000000000351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Lucas Philipp
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Christopher Miller
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Chengyuan Wu
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
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12
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Mamelak AN. In Reply: Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results. Oper Neurosurg (Hagerstown) 2022; 23:e218-e219. [PMID: 35972124 DOI: 10.1227/ons.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Adam N Mamelak
- Department of Neurological Surgery, Functional and Epilepsy Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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