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Kobayashi K, Ikeda A. Ictal Semiology Important for Electrode Implantation and Interpretation of Stereoelectroencephalography. Neurol Med Chir (Tokyo) 2024; 64:215-221. [PMID: 38719581 PMCID: PMC11230871 DOI: 10.2176/jns-nmc.2023-0265] [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] [Indexed: 06/18/2024] Open
Abstract
Scalp video-electroencephalography (video-EEG) monitoring should be analyzed thoroughly to preoperatively evaluate stereoelectroencephalography (SEEG). Formulating the working hypotheses for the epileptogenic zone (EZ) considering "anatomo-electroclinical correlations" is the most crucial step, which determines the placement of SEEG electrodes. If these hypotheses are insufficient, precise EZ identification may not be achieved during SEEG recording.In ictal semiology analysis, temporal and spatial patterns with reference to ictal EEG changes are emphasized. In frontal lobe epilepsy, seizures often begin with relatively widespread synchronous activity, and complex motor symptoms manifest within seconds. Due to the wide area involved and intense interhemispheric connectivity, a comprehensive evaluation is often required. Hypotheses are formulated on the basis of the motor symptoms and emotional manifestations that are related to the prefrontal cortices. In temporal lobe epilepsy, EEG onset often precedes clinical onset. Propagation from the EZ to locations within and outside of the temporal lobe is examined from both the EEG and semiological standpoint. The characteristics of contralateral versive seizures, contralateral tonic seizures, and frequent focal onset bilateral tonic-clonic seizures indicate a higher risk of temporo-perisylvian epilepsy. In parietal/occipital lobe epilepsy, despite that some symptoms result from activity in the immediate vicinity, stronger connectivity with other regions usually contributes to the generation of prominent ictal semiology. Hence, multilobar electrode placement is often useful in practice. For insular epilepsy, it is important to understand the anatomy, function, and networks between other regions. A semiological approach is one of the most important clues for electrode implantation and interpretation of SEEG.
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Affiliation(s)
- Katsuya Kobayashi
- Department of Neurology, Kyoto University Graduate School of Medicine
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine
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Restrepo CE, Balaguera P, Thompson SA, Johnson J, Lacuey N, Pati S, Harris K, Lhatoo SD, Tandon N. Safety and efficacy of bihemispheric sampling via transmidline stereoelectroencephalography. J Neurosurg 2022:1-9. [PMID: 36585867 DOI: 10.3171/2022.11.jns221144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/16/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) is designed to target distributed cortical networks responsible for electroclinical seizure syndrome and to enable localization of the site of seizure onset in patients with intractable epilepsy. When the preimplantation hypothesis invokes the bilateral mesial frontal lobes, sampling of several deep-seated cortical sites in both hemispheres is required. In this study, the authors have demonstrated the feasibility of sampling bihemispheric areas with intentional implantation of an SEEG electrode crossing the midline (SECM) for sampling the cortex on both sides of the interhemispheric fissure. METHODS An analysis of 231 consecutive SEEG procedures over 8 years was used to identify instances of bihemispheric sampling by using the transmidline SEEG technique. RESULTS The authors identified 53 SEEG cases, with a total of 126 electrodes that crossed the interhemispheric fissure; all were in the frontal lobes. Eighty-three electrodes targeted the cingulate gyrus (18 rostral, 43 anterior, and 22 middle), 31 targeted the posterior orbitofrontal region, 8 sampled the medial prefrontal cortex, and 4 targeted nodular heterotopia around the frontal horns. The ictal onset zone was localized to the frontal lobe in 16 cases. SECM isolated interictal and ictal activity in the contralateral hemisphere in 6 cases and independent bihemispheric seizure activity in 2 cases. No hemorrhagic or infectious complications were noted in any of these cases. CONCLUSIONS Based on this extensive experience of bihemispheric sampling, the authors concluded that this technique is safe and effective. In this series, SECM showed contralateral interictal and/or ictal epileptiform activity in 8 (15%) cases, and 9 (16%) cases (with unilateral implantation) had sufficient data to discard contralateral involvement, contributing to support of the epileptogenic network. SECM may reduce the number of electrodes used to sample bilateral mesial frontal or orbitofrontal cortices, and such an approach may lower the risk of hemorrhage and costs.
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Affiliation(s)
- Carlos E Restrepo
- 1Vivian L. Smith Department of Neurosurgery, McGovern Medical School at University of Texas Health Science Center at Houston.,2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Pedro Balaguera
- 2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,3Department of Neurology, McGovern Medical School at University of Texas Health Science Center at Houston; and.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Stephen A Thompson
- 2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,3Department of Neurology, McGovern Medical School at University of Texas Health Science Center at Houston; and.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Jessica Johnson
- 1Vivian L. Smith Department of Neurosurgery, McGovern Medical School at University of Texas Health Science Center at Houston.,2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston
| | - Nuria Lacuey
- 2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,3Department of Neurology, McGovern Medical School at University of Texas Health Science Center at Houston; and.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Sandipan Pati
- 2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,3Department of Neurology, McGovern Medical School at University of Texas Health Science Center at Houston; and.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Katherine Harris
- 2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,3Department of Neurology, McGovern Medical School at University of Texas Health Science Center at Houston; and.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Samden D Lhatoo
- 2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,3Department of Neurology, McGovern Medical School at University of Texas Health Science Center at Houston; and.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Nitin Tandon
- 1Vivian L. Smith Department of Neurosurgery, McGovern Medical School at University of Texas Health Science Center at Houston.,2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
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A comparison between robot-guided and stereotactic frame-based stereoelectroencephalography (SEEG) electrode implantation for drug-resistant epilepsy. J Robot Surg 2022; 17:1013-1020. [DOI: 10.1007/s11701-022-01504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
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Validation of 3D fluoroscopy for image-guidance registration in depth electrode implantation for medically refractory epilepsy. Acta Neurochir (Wien) 2021; 163:1347-1354. [PMID: 33443679 DOI: 10.1007/s00701-021-04706-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Frame registration is a critical step to ensure accurate electrode placement in stereotactic procedures such as stereoelectroencephalography (SEEG) and is routinely done by merging a computed tomography (CT) scan with the preoperative magnetic resonance (MR) examination. Three-dimensional fluoroscopy (XT) has emerged as a method for intraoperative electrode verification following electrode implantation and more recently has been proposed as a registration method with several advantages. METHODS We compared the accuracy of SEEG electrode placement by frame registration with CT and XT imaging by analyzing the Euclidean distance between planned and post-implantation trajectories of the SEEG electrodes to calculate the error in both the entry (EP) and target (TP) points. Other variables included radiation dose, efficiency, and complications. RESULTS Twenty-seven patients (13 CT and 14 XT) underwent placement of SEEG electrodes (319 in total). The mean EP and TP errors for the CT group were 2.3 mm and 3.3 mm, respectively, and 1.9 mm and 2.9 mm for the XT group, with no statistical difference (p = 0.75 and p = 0.246). The time to first electrode placement was similar (XT, 82 ± 10 min; CT, 84 ± 22 min; p = 0.858) and the average radiation exposure with XT (234 ± 55 mGy*cm) was significantly lower than CT (1245 ± 123 mGy*cm) (p < 0.0001). Four complications were documented with equal incidence in both groups. CONCLUSIONS The use of XT as a method for registration resulted in similar implantation accuracy compared with CT. Advantages of XT are the substantial reduction in radiation dose and the elimination of the need to transfer the patient out of the room which may have an impact on patient safety and OR efficiency.
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Tandon N, Tong BA, Friedman ER, Johnson JA, Von Allmen G, Thomas MS, Hope OA, Kalamangalam GP, Slater JD, Thompson SA. Analysis of Morbidity and Outcomes Associated With Use of Subdural Grids vs Stereoelectroencephalography in Patients With Intractable Epilepsy. JAMA Neurol 2020; 76:672-681. [PMID: 30830149 DOI: 10.1001/jamaneurol.2019.0098] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance A major change has occurred in the evaluation of epilepsy with the availability of robotic stereoelectroencephalography (SEEG) for seizure localization. However, the comparative morbidity and outcomes of this minimally invasive procedure relative to traditional subdural electrode (SDE) implantation are unknown. Objective To perform a comparative analysis of the relative efficacy, procedural morbidity, and epilepsy outcomes consequent to SEEG and SDE in similar patient populations and performed by a single surgeon at 1 center. Design, Setting and Participants Overall, 239 patients with medically intractable epilepsy underwent 260 consecutive intracranial electroencephalographic procedures to localize their epilepsy. Procedures were performed from November 1, 2004, through June 30, 2017, and data were analyzed in June 2017 and August 2018. Interventions Implantation of SDE using standard techniques vs SEEG using a stereotactic robot, followed by resection or laser ablation of the seizure focus. Main Outcomes and Measures Length of surgical procedure, surgical complications, opiate use, and seizure outcomes using the Engel Epilepsy Surgery Outcome Scale. Results Of the 260 cases included in the study (54.6% female; mean [SD] age at evaluation, 30.3 [13.1] years), the SEEG (n = 121) and SDE (n = 139) groups were similar in age (mean [SD], 30.1 [12.2] vs 30.6 [13.8] years), sex (47.1% vs 43.9% male), numbers of failed anticonvulsants (mean [SD], 5.7 [2.5] vs 5.6 [2.5]), and duration of epilepsy (mean [SD], 16.4 [12.0] vs17.2 [12.1] years). A much greater proportion of SDE vs SEEG cases were lesional (99 [71.2%] vs 53 [43.8%]; P < .001). Seven symptomatic hemorrhagic sequelae (1 with permanent neurological deficit) and 3 infections occurred in the SDE cohort with no clinically relevant complications in the SEEG cohort, a marked difference in complication rates (P = .003). A greater proportion of SDE cases resulted in resection or ablation compared with SEEG cases (127 [91.4%] vs 90 [74.4%]; P < .001). Favorable epilepsy outcomes (Engel class I [free of disabling seizures] or II [rare disabling seizures]) were observed in 57 of 75 SEEG cases (76.0%) and 59 of 108 SDE cases (54.6%; P = .003) amongst patients undergoing resection or ablation, at 1 year. An analysis of only nonlesional cases revealed good outcomes in 27 of 39 cases (69.2%) vs 9 of 26 cases (34.6%) at 12 months in SEEG and SDE cohorts, respectively (P = .006). When considering all patients undergoing evaluation, not just those undergoing definitive procedures, favorable outcomes (Engel class I or II) for SEEG compared with SDE were similar (57 of 121 [47.1%] vs 59 of 139 [42.4%] at 1 year; P = .45). Conclusions and Relevance This direct comparison of large matched cohorts undergoing SEEG and SDE implantation reveals distinctly better procedural morbidity favoring SEEG. These modalities intrinsically evaluate somewhat different populations, with SEEG being more versatile and applicable to a range of scenarios, including nonlesional and bilateral cases, than SDE. The significantly favorable adverse effect profile of SEEG should factor into decision making when patients with pharmacoresistant epilepsy are considered for intracranial evaluations.
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Affiliation(s)
- Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health, Houston.,Mischer Neuroscience Institute, Memorial Hermann Hospital, Texas Medical Center, Houston
| | - Brian A Tong
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health, Houston
| | - Elliott R Friedman
- Department of Radiology, McGovern Medical School, University of Texas Health, Houston
| | - Jessica A Johnson
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health, Houston.,Mischer Neuroscience Institute, Memorial Hermann Hospital, Texas Medical Center, Houston
| | - Gretchen Von Allmen
- Department of Pediatrics, McGovern Medical School, University of Texas Health, Houston
| | - Melissa S Thomas
- Department of Neurology, McGovern Medical School, University of Texas Health, Houston
| | - Omotola A Hope
- Department of Neurology, McGovern Medical School, University of Texas Health, Houston
| | | | - Jeremy D Slater
- Department of Neurology, McGovern Medical School, University of Texas Health, Houston
| | - Stephen A Thompson
- Department of Neurology, McGovern Medical School, University of Texas Health, Houston
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Li G, Jiang S, Chen C, Brunner P, Wu Z, Schalk G, Chen L, Zhang D. iEEGview: an open-source multifunction GUI-based Matlab toolbox for localization and visualization of human intracranial electrodes. J Neural Eng 2019; 17:016016. [PMID: 31658449 DOI: 10.1088/1741-2552/ab51a5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The precise localization of intracranial electrodes is a fundamental step relevant to the analysis of intracranial electroencephalography (iEEG) recordings in various fields. With the increasing development of iEEG studies in human neuroscience, higher requirements have been posed on the localization process, resulting in urgent demand for more integrated, easy-operation and versatile tools for electrode localization and visualization. With the aim of addressing this need, we develop an easy-to-use and multifunction toolbox called iEEGview, which can be used for the localization and visualization of human intracranial electrodes. APPROACH iEEGview is written in Matlab scripts and implemented with a GUI. From the GUI, by taking only pre-implant MRI and post-implant CT images as input, users can directly run the full localization pipeline including brain segmentation, image co-registration, electrode reconstruction, anatomical information identification, activation map generation and electrode projection from native brain space into common brain space for group analysis. Additionally, iEEGview implements methods for brain shift correction, visual location inspection on MRI slices and computation of certainty index in anatomical label assignment. MAIN RESULTS All the introduced functions of iEEGview work reliably and successfully, and are tested by images from 28 human subjects implanted with depth and/or subdural electrodes. SIGNIFICANCE iEEGview is the first public Matlab GUI-based software for intracranial electrode localization and visualization that holds integrated capabilities together within one pipeline. iEEGview promotes convenience and efficiency for the localization process, provides rich localization information for further analysis and offers solutions for addressing raised technical challenges. Therefore, it can serve as a useful tool in facilitating iEEG studies.
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Affiliation(s)
- Guangye Li
- State Key Laboratory of Mechanical Systems and Vibrations, Institute of Robotics, Shanghai Jiao Tong University, Shanghai, People's Republic of China. National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, United States of America
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Iordanou JC, Camara D, Ghatan S, Panov F. Approach Angle Affects Accuracy in Robotic Stereoelectroencephalography Lead Placement. World Neurosurg 2019; 128:e322-e328. [DOI: 10.1016/j.wneu.2019.04.143] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 11/30/2022]
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Minkin K, Gabrovski K, Penkov M, Todorov Y, Tanova R, Milenova Y, Romansky K, Dimova P. Stereoelectroencephalography Using Magnetic Resonance Angiography for Avascular Trajectory Planning: Technical Report. Neurosurgery 2018; 81:688-695. [PMID: 28419357 DOI: 10.1093/neuros/nyx166] [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: 07/11/2016] [Accepted: 03/11/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Stereoelectroencephalography (SEEG) requires high-quality angiographic studies because avascular trajectory planning is a prerequisite for the safety of this procedure. Some epilepsy surgery groups have begun to use computed tomography angiography and magnetic resonance T1-weighted sequence with contrast enhancement for this purpose. OBJECTIVE To present the first series of patients with avascular trajectory planning of SEEG based on magnetic resonance angiography (MRA). METHODS Thirty-six SEEG explorations for drug-resistant focal epilepsy were performed from January 2013 to December 2015. A retrospective analysis of this consecutive surgical series was then performed. Magnetic resonance imaging included MRA with a modified contrast-enhanced magnetic resonance venography (MRV) protocol with a short acquisition delay, which allowed simultaneous arterial and venous visualization. Our criteria for satisfactory MRA were the visualization of at least first-order branches of the angular artery, paracentral and calcarine artery, and third-order tributaries of the superficial Sylvian vein, vein of Labbe, and vein of Trolard. RESULTS Thirty-four patients underwent 36 SEEG explorations with 369 electrodes carrying 4321 contacts. Contrast-enhanced MRA using the MRV protocol was judged satisfactory for SEEG planning in all explorations. Postoperative complications were not observed in our series of 36 SEEG explorations, which included 50 transopercular insular trajectories. CONCLUSION MRA using an MRV protocol may be applied for avascular trajectory planning during SEEG procedures. This technique provides a simultaneous visualization of cortical arteries and veins without the need for additional radiation exposure or intra-arterial catheter placement.
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Affiliation(s)
- Krasimir Minkin
- Department of Neurosurgery, University Hospital "Saint Ivan Rilski," Sofia, Bulgaria
| | - Kaloyan Gabrovski
- Department of Neurosurgery, University Hospital "Saint Ivan Rilski," Sofia, Bulgaria
| | - Marin Penkov
- Department of Neuroradio-logy, University Hospital "Saint Ivan Rilski," Sofia, Bulgaria
| | - Yuri Todorov
- Department of Neuroradio-logy, University Hospital "Saint Ivan Rilski," Sofia, Bulgaria
| | - Rositsa Tanova
- Department of Neurosurgery, University Hospital "Saint Ivan Rilski," Sofia, Bulgaria
| | - Yoana Milenova
- Department of Neurosurgery, University Hospital "Saint Ivan Rilski," Sofia, Bulgaria
| | - Kiril Romansky
- Department of Neurosurgery, University Hospital "Saint Ivan Rilski," Sofia, Bulgaria
| | - Petia Dimova
- Department of Neurosurgery, University Hospital "Saint Ivan Rilski," Sofia, Bulgaria
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Cardinale F, Rizzi M, d'Orio P, Casaceli G, Arnulfo G, Narizzano M, Scorza D, De Momi E, Nichelatti M, Redaelli D, Sberna M, Moscato A, Castana L. A new tool for touch-free patient registration for robot-assisted intracranial surgery: application accuracy from a phantom study and a retrospective surgical series. Neurosurg Focus 2018; 42:E8. [PMID: 28463615 DOI: 10.3171/2017.2.focus16539] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the accuracy of Neurolocate frameless registration system and frame-based registration for robotic stereoelectroencephalography (SEEG). METHODS The authors performed a 40-trajectory phantom laboratory study and a 127-trajectory retrospective analysis of a surgical series. The laboratory study was aimed at testing the noninferiority of the Neurolocate system. The analysis of the surgical series compared Neurolocate-based SEEG implantations with a frame-based historical control group. RESULTS The mean localization errors (LE) ± standard deviations (SD) for Neurolocate-based and frame-based trajectories were 0.67 ± 0.29 mm and 0.76 ± 0.34 mm, respectively, in the phantom study (p = 0.35). The median entry point LE was 0.59 mm (interquartile range [IQR] 0.25-0.88 mm) for Neurolocate-registration-based trajectories and 0.78 mm (IQR 0.49-1.08 mm) for frame-registration-based trajectories (p = 0.00002) in the clinical study. The median target point LE was 1.49 mm (IQR 1.06-2.4 mm) for Neurolocate-registration-based trajectories and 1.77 mm (IQR 1.25-2.5 mm) for frame-registration-based trajectories in the clinical study. All the surgical procedures were successful and uneventful. CONCLUSIONS The results of the phantom study demonstrate the noninferiority of Neurolocate frameless registration. The results of the retrospective surgical series analysis suggest that Neurolocate-based procedures can be more accurate than the frame-based ones. The safety profile of Neurolocate-based registration should be similar to that of frame-based registration. The Neurolocate system is comfortable, noninvasive, easy to use, and potentially faster than other registration devices.
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Affiliation(s)
| | - Michele Rizzi
- "Claudio Munari" Center for Epilepsy Surgery and.,Department of Neuroscience, University of Parma
| | | | | | - Gabriele Arnulfo
- Department of Informatics, Bioengineering, Robotics, and System Engineering (DIBRIS), University of Genova, Italy; and
| | - Massimo Narizzano
- Department of Informatics, Bioengineering, Robotics, and System Engineering (DIBRIS), University of Genova, Italy; and
| | - Davide Scorza
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano.,eHealth and Biomedical Applications, Vicomtech-IK4, San Sebastián, Spain
| | - Elena De Momi
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano
| | | | | | | | - Alessio Moscato
- Department of Medical Physics, Bassini Hospital-Cinisello Balsamo, Milan
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Joswig H, Benson CM, Parrent AG, MacDougall KW, Steven DA. Operative Nuances of Stereotactic Leksell Frame-Based Depth Electrode Implantation. Oper Neurosurg (Hagerstown) 2017; 15:292-295. [DOI: 10.1093/ons/opx245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/24/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
For intracranial electroencephalographic monitoring, stereotactically implanted depth electrodes are increasingly used at epilepsy centers around the world.
Objective
To identify pearls and pitfalls from our experience with stereotactic Leksell (Elekta AB, Stockhom, Sweden) frame-based depth electrode implantation.
Methods
An intraoperative video of the implantation technique was recorded.
Results
A detailed description and a video on how to implant depth electrodes using the stereotactic Leksell frame is provided.
Conclusion
Neurosurgeons implanting depth electrodes for intracranial electroencephalographic monitoring might find the technical nuances and caveats described in this technical note useful for their practice.
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Affiliation(s)
- Holger Joswig
- Epilepsy Program, Department of Clinical Neurological Sciences, Division of Neu-rosurgery, London Health Sciences Cen-tre, University Hospital, London, Ontario, Canada
| | - Carolyn M Benson
- Epilepsy Program, Department of Clinical Neurological Sciences, Division of Neu-rosurgery, London Health Sciences Cen-tre, University Hospital, London, Ontario, Canada
| | - Andrew G Parrent
- Epilepsy Program, Department of Clinical Neurological Sciences, Division of Neu-rosurgery, London Health Sciences Cen-tre, University Hospital, London, Ontario, Canada
| | - Keith W MacDougall
- Epilepsy Program, Department of Clinical Neurological Sciences, Division of Neu-rosurgery, London Health Sciences Cen-tre, University Hospital, London, Ontario, Canada
| | - David A Steven
- Epilepsy Program, Department of Clinical Neurological Sciences, Division of Neu-rosurgery, London Health Sciences Cen-tre, University Hospital, London, Ontario, Canada
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Narizzano M, Arnulfo G, Ricci S, Toselli B, Tisdall M, Canessa A, Fato MM, Cardinale F. SEEG assistant: a 3DSlicer extension to support epilepsy surgery. BMC Bioinformatics 2017; 18:124. [PMID: 28231759 PMCID: PMC5324222 DOI: 10.1186/s12859-017-1545-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 02/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background In the evaluation of Stereo-Electroencephalography (SEEG) signals, the physicist’s workflow involves several operations, including determining the position of individual electrode contacts in terms of both relationship to grey or white matter and location in specific brain regions. These operations are (i) generally carried out manually by experts with limited computer support, (ii) hugely time consuming, and (iii) often inaccurate, incomplete, and prone to errors. Results In this paper we present SEEG Assistant, a set of tools integrated in a single 3DSlicer extension, which aims to assist neurosurgeons in the analysis of post-implant structural data and hence aid the neurophysiologist in the interpretation of SEEG data. SEEG Assistant consists of (i) a module to localize the electrode contact positions using imaging data from a thresholded post-implant CT, (ii) a module to determine the most probable cerebral location of the recorded activity, and (iii) a module to compute the Grey Matter Proximity Index, i.e. the distance of each contact from the cerebral cortex, in order to discriminate between white and grey matter location of contacts. Finally, exploiting 3DSlicer capabilities, SEEG Assistant offers a Graphical User Interface that simplifies the interaction between the user and the tools. SEEG Assistant has been tested on 40 patients segmenting 555 electrodes, and it has been used to identify the neuroanatomical loci and to compute the distance to the nearest cerebral cortex for 9626 contacts. We also performed manual segmentation and compared the results between the proposed tool and gold-standard clinical practice. As a result, the use of SEEG Assistant decreases the post implant processing time by more than 2 orders of magnitude, improves the quality of results and decreases, if not eliminates, errors in post implant processing. Conclusions The SEEG Assistant Framework for the first time supports physicists by providing a set of open-source tools for post-implant processing of SEEG data. Furthermore, SEEG Assistant has been integrated into 3D Slicer, a software platform for the analysis and visualization of medical images, overcoming limitations of command-line tools.
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Affiliation(s)
- Massimo Narizzano
- Department of Informatics, Bioengineering Robotics and System engineering (DIBRIS), University of Genoa, Viale Causa 13, Genova, 16143, Italy
| | - Gabriele Arnulfo
- Department of Informatics, Bioengineering Robotics and System engineering (DIBRIS), University of Genoa, Viale Causa 13, Genova, 16143, Italy.
| | - Serena Ricci
- Departement of Physiology Pharmacology and Neuroscience, CUNY Medical School, New York, New York, USA
| | - Benedetta Toselli
- Department of Informatics, Bioengineering Robotics and System engineering (DIBRIS), University of Genoa, Viale Causa 13, Genova, 16143, Italy
| | - Martin Tisdall
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, WC1N 3JH, London, UK
| | - Andrea Canessa
- Department of Informatics, Bioengineering Robotics and System engineering (DIBRIS), University of Genoa, Viale Causa 13, Genova, 16143, Italy
| | - Marco Massimo Fato
- Department of Informatics, Bioengineering Robotics and System engineering (DIBRIS), University of Genoa, Viale Causa 13, Genova, 16143, Italy
| | - Francesco Cardinale
- "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
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