1
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Anderson W, Ponce FA, Kinsman MJ, Sani S, Hwang B, Ghinda D, Kogan M, Mahoney JM, Amin DB, Van Horn M, McGuckin JP, Razo-Castaneda D, Bucklen BS. Robotic-Assisted Navigation for Stereotactic Neurosurgery: A Cadaveric Investigation of Accuracy, Time, and Radiation. Oper Neurosurg (Hagerstown) 2023; 26:01787389-990000000-00991. [PMID: 38054727 PMCID: PMC11008650 DOI: 10.1227/ons.0000000000001024] [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: 08/14/2023] [Accepted: 10/18/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite frequent use, stereotactic head frames require manual coordinate calculations and manual frame settings that are associated with human error. This study examines freestanding robot-assisted navigation (RAN) as a means to reduce the drawbacks of traditional cranial stereotaxy and improve targeting accuracy. METHODS Seven cadaveric human torsos with heads were tested with 8 anatomic coordinates selected for lead placement mirrored in each hemisphere. Right and left hemispheres of the brain were randomly assigned to either the traditional stereotactic arc-based (ARC) group or the RAN group. Both target accuracy and trajectory accuracy were measured. Procedural time and the radiation required for registration were also measured. RESULTS The accuracy of the RAN group was significantly greater than that of the ARC group in both target (1.2 ± 0.5 mm vs 1.7 ± 1.2 mm, P = .005) and trajectory (0.9 ± 0.6 mm vs 1.3 ± 0.9 mm, P = .004) measurements. Total procedural time was also significantly faster for the RAN group than for the ARC group (44.6 ± 7.7 minutes vs 86.0 ± 12.5 minutes, P < .001). The RAN group had significantly reduced time per electrode placement (2.9 ± 0.9 minutes vs 5.8 ± 2.0 minutes, P < .001) and significantly reduced radiation during registration (1.9 ± 1.1 mGy vs 76.2 ± 5.0 mGy, P < .001) compared with the ARC group. CONCLUSION In this cadaveric study, cranial leads were placed faster and with greater accuracy using RAN than those placed with conventional stereotactic arc-based technique. RAN also required significantly less radiation to register the specimen's coordinate system to the planned trajectories. Clinical testing should be performed to further investigate RAN for stereotactic cranial surgery.
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Affiliation(s)
- William Anderson
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Francisco A. Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael J. Kinsman
- Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Hwang
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
- Current Affiliation: Orange County Neurosurgical Associates, Laguna Hills, California, USA
| | - Diana Ghinda
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michael Kogan
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Jonathan M. Mahoney
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, Pennsylvania, USA
| | - Dhara B. Amin
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, Pennsylvania, USA
| | - Margaret Van Horn
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, Pennsylvania, USA
| | - Joshua P. McGuckin
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, Pennsylvania, USA
| | - Dominic Razo-Castaneda
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Brandon S. Bucklen
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, Pennsylvania, USA
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2
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Brimley C, Shimony N. Accuracy and Utility of Frameless Stereotactic Placement of Stereoelectroencephalography Electrodes. World Neurosurg 2023; 180:e226-e232. [PMID: 37739177 DOI: 10.1016/j.wneu.2023.09.040] [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: 04/21/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Successful surgery for epilepsy hinges on identification of the epileptogenic focus. Stereoelectroencephalography (sEEG) is the most effective way to identify most seizure foci. There are multiple methods of inserting depth electrodes, including frame-based, frameless, and robot-assisted techniques. Studies have shown the accuracy of frame-based and robotic-assisted techniques to be statistically similar, while only one study has detailed the frameless sEEG insertion technique. METHODS Patients underwent placement of sEEG depth electrodes using frameless stereotaxy from September 2019 to September 2021 at Geisinger Medical Center by a single surgeon. Seizure history, electrode placement accuracy relative to the planned trajectories, surgical times, success rate of identifying the epileptogenic focus, and subsequent seizure control rates after surgical treatment were documented. RESULTS Data were available for 21 patients and 181 electrodes inserted using the VarioGuide frameless stereotactic system. Each insertion took an average of 14.5 minutes per lead. Average entry variance was 2.7 mm with an average target variance of 4.6 mm. The epileptogenic focus was identified in 19 of 21 patients, and further surgical treatment was performed in 18 of 21 patients (85.7%). CONCLUSIONS VarioGuide frameless stereotaxy for sEEG placement is comparable to frame-based and robotic-assisted techniques with statistically similar rates of epileptic focus identification. Lead placement accuracy is slightly lower and time per lead is slightly higher relative to robot-assisted surgeries. When a robot system is unavailable, surgeons can consider using a frameless stereotactic technique for sEEG insertion, allowing patients to benefit from a similarly high rate of epileptic zone identification.
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Affiliation(s)
- Cameron Brimley
- Geisinger Neuroscience Institute, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania, USA; Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA; Department of Neurosurgery, University of Tennessee Health Science Center/Semmes-Murphey Clinic, Memphis, Tennessee, USA.
| | - Nir Shimony
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA; Department of Neurosurgery, University of Tennessee Health Science Center/Semmes-Murphey Clinic, Memphis, Tennessee, USA
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3
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Joris V, Ribeiro-Vaz JG, Finet P, El Tahry R, Elkaim LM, Raftopoulos C, Ferrao-Santos S. Stereoelectroencephalography Implantation Using Frameless Neuronavigation and Varioguide: Prospective Analysis of Accuracy and Safety in a Case Series of 11 Patients. World Neurosurg 2023; 174:e62-e71. [PMID: 36871656 DOI: 10.1016/j.wneu.2023.02.116] [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: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Stereoencephalography (SEEG) is becoming a widespread diagnostic procedure for drug-resistant epilepsy investigation. Techniques include frame-based and robot-assisted implantation, and more recently, frameless neuronavigated systems (FNSs). Despite its recent use, the accuracy and safety of FNS are still under investigation. OBJECTIVE To assess in a prospective study the accuracy and safety of a specific FNS use for SEEG implantation. METHODS Twelve patients who underwent SEEG implantation using FNS (Varioguide [Brainlab]) were included in this study. Data were collected prospectively and included demographic data, postoperative complications, functional results, and implantation characteristics (i.e., duration and number of electrodes). Further analysis included accuracy at entry point and target using measurements of the euclidean distance between planned and actual trajectories. RESULTS Eleven patients underwent SEEG-FNS implantation from May 2019 to March 2020. One patient did not undergo surgery because of a bleeding disorder. The mean target deviation was 4.06 mm, and mean entry point deviation was 4.2 mm, with insular electrodes significantly more deviated. Results excluding insular electrodes showed a mean target deviation of 3.66 mm and a mean entry point deviation of 3.77 mm. No severe complications occurred; a few mild to moderate adverse events were reported (1 superficial infection, 1 seizure cluster, and 3 transient neurologic impairments). The mean implantation duration by electrodes was 18.5 minutes. CONCLUSIONS Implantation of depth electrodes for SEEG using FNS seems to be safe, but larger prospective studies are needed to validate these results. Accuracy is sufficient for noninsular trajectories but warrant caution for insular trajectories with statistically significantly less accuracy.
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Affiliation(s)
- Vincent Joris
- Department of Neurosurgery, Cliniques Universitaires St-Luc, Woluwe-St-Lambert, Belgium.
| | | | - Patrice Finet
- Department of Neurosurgery, Cliniques Universitaires St-Luc, Woluwe-St-Lambert, Belgium
| | - Riëm El Tahry
- Department of Neurology, Cliniques Universitaires St-Luc, Woluwe-St-Lambert, Belgium
| | - Lior M Elkaim
- Division of Neurology and Neurosurgery, McGill University, McGill University Health Center, Montreal, Quebec, Canada
| | - Christian Raftopoulos
- Department of Neurosurgery, Cliniques Universitaires St-Luc, Woluwe-St-Lambert, Belgium
| | - Susana Ferrao-Santos
- Department of Neurology, Cliniques Universitaires St-Luc, Woluwe-St-Lambert, Belgium
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4
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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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5
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Fiani B, Jarrah R, Doan T, Shields J, Houston R, Sarno E. Stereoelectroencephalography versus Subdural Electrode Implantation to Determine Whether Patients with Drug-resistant Epilepsy Are Candidates for Epilepsy Surgery. Neurol Med Chir (Tokyo) 2021; 61:347-355. [PMID: 33967179 PMCID: PMC8258005 DOI: 10.2176/nmc.ra.2020-0361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Epilepsy is a chronic condition that affects about 50 million individuals worldwide. While its challenges are profound, there are increasing instances where antiepileptic drugs (AEDs) fail to provide relief to epileptic manifestations. For these pharmacoresistant cases, epilepsy surgery often is an effective route for treatment. However, the complexity and challenges associated with presurgical evaluations have prevented more widespread utilization of epilepsy surgery in pharmacoresistant cases. While preliminary work-ups and non-invasive diagnostic imaging have allowed for limited identification of the epileptogenic zone (EZ), there is yet to be an established pre-determined algorithm for surgical evaluation of patients with epilepsy. However, two modalities are currently being used for localization of the EZ and in determining candidates for surgery: stereoelectroencephalography (SEEG) and subdural electrodes (SDEs). SDE has been used in the United States for decades; however, SEEG now provides a less invasive option for mapping brain regions. We seek to address which intracranial monitoring technique is superior. Through a review of the outcomes of various clinical studies, SEEG was found to have greater safety and efficiency benefits than SDE, such as lower morbidity rates, lower prevalence of neurological deficits, and shorter recovery times. Moreover, SEEG was also found to have further functional benefits by allowing for deeper targeting of cerebral tissue along with bilateral hemispheric monitoring. This has led to increased rates of seizure freedom and control among SEEG patients. Nevertheless, further studies on the limitations and advancements of SEEG and SDE are still required to provide a more comprehensive understanding regarding their application.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center
| | | | | | | | | | - Erika Sarno
- Michigan State University College of Osteopathic Medicine
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6
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Ladisich B, Machegger L, Romagna A, Krainz H, Steinbacher J, Leitinger M, Kalss G, Thon N, Trinka E, Winkler PA, Schwartz C. VarioGuide® frameless neuronavigation-guided stereoelectroencephalography in adult epilepsy patients: technique, accuracy and clinical experience. Acta Neurochir (Wien) 2021; 163:1355-1364. [PMID: 33580853 PMCID: PMC8053662 DOI: 10.1007/s00701-021-04755-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022]
Abstract
Background Stereoelectroencephalography (SEEG) allows the identification of deep-seated seizure foci and determination of the epileptogenic zone (EZ) in drug-resistant epilepsy (DRE) patients. We evaluated the accuracy and treatment-associated morbidity of frameless VarioGuide® (VG) neuronavigation-guided depth electrode (DE) implantations. Methods We retrospectively identified all consecutive adult DRE patients, who underwent VG-neuronavigation DE implantations, between March 2013 and April 2019. Clinical data were extracted from the electronic patient charts. An interdisciplinary team agreed upon all treatment decisions. We performed trajectory planning with iPlan® Cranial software and DE implantations with the VG system. Each electrode’s accuracy was assessed at the entry (EP), the centre (CP) and the target point (TP). We conducted correlation analyses to identify factors associated with accuracy. Results The study population comprised 17 patients (10 women) with a median age of 32.0 years (range 21.0–54.0). In total, 220 DEs (median length 49.3 mm, range 25.1–93.8) were implanted in 21 SEEG procedures (range 3–16 DEs/surgery). Adequate signals for postoperative SEEG were detected for all but one implanted DEs (99.5%); in 15/17 (88.2%) patients, the EZ was identified and 8/17 (47.1%) eventually underwent focus resection. The mean deviations were 3.2 ± 2.4 mm for EP, 3.0 ± 2.2 mm for CP and 2.7 ± 2.0 mm for TP. One patient suffered from postoperative SEEG-associated morbidity (i.e. conservatively treated delayed bacterial meningitis). No mortality or new neurological deficits were recorded. Conclusions The accuracy of VG-SEEG proved sufficient to identify EZ in DRE patients and associated with a good risk-profile. It is a viable and safe alternative to frame-based or robotic systems. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-04755-w.
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Affiliation(s)
- Barbara Ladisich
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, A-5020, Salzburg, Austria
| | - Lukas Machegger
- University Institute of Neuroradiology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Alexander Romagna
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, A-5020, Salzburg, Austria
- Department of Neurosurgery, München Klinik Bogenhausen, Englschalkingerstr. 77, 81925, Munich, Germany
| | - Herbert Krainz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, A-5020, Salzburg, Austria
| | - Jürgen Steinbacher
- University Institute of Neuroradiology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Markus Leitinger
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Niklas Thon
- Department of Neurosurgery, University Hospital Munich, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Eugen Trinka
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Peter A Winkler
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, A-5020, Salzburg, Austria
| | - Christoph Schwartz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, A-5020, Salzburg, Austria.
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7
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Grewal SS, Benscoter M, Kuehn S, Lundstrom BN, Stead M, Worrell G, Van Gompel JJ. Minimally Invasive, Endoscopic-Assisted Device for Subdural Electrode Implantation in Epilepsy. Oper Neurosurg (Hagerstown) 2021; 18:92-97. [PMID: 31120115 DOI: 10.1093/ons/opz104] [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: 09/06/2018] [Accepted: 01/13/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Subdural grids and strip electrodes provide wide coverage of the cerebral cortex, precise delineation of the extent of the seizure onset zone, and improved spatial sampling to perform functional mapping for eloquent cortex. OBJECTIVE To describe a novel device that allows for a minimally invasive approach to implantation of subdural grid and strip electrodes. METHODS A skull mounted device was created to allow for implantation of subdural electrodes through a keyhole craniotomy with direct visualization using the aid of a flexible neurovideoscope. The initial studies in preparation for grid development performed on cadaveric skulls were analyzed to determine the size of craniotomy required for deployment, maximal distance of strip electrode deployment from center of craniotomy, and visual inspection of the cortex was performed for any underlying damage. RESULTS The device allowed for the placement of subdural electrodes through a 40-mm craniotomy. Subdural electrodes were deployed in multiple directions to a distance of a 70-mm radius from the center of the craniotomy. There was no visual damage to the underlying cortex after the procedures were completed. CONCLUSION Large craniotomies are typically desired to provide direct visualization of the implantation of subdural electrodes, but can increase the risk of subdural hemorrhages and infections. This study describes a novel minimally invasive endoscopically assisted device for the implantation of subdural strip electrodes under direct visualization. With this device, we are able to limit the size of the craniotomy, avoid incision through the temporalis muscle, and implant subdural electrodes with visualization of the cortex.
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Affiliation(s)
- Sanjeet S Grewal
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mark Benscoter
- Division of Engineering, Mayo Clinic, Rochester, Minnesota.,Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Department of Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Stephen Kuehn
- Division of Engineering, Mayo Clinic, Rochester, Minnesota
| | | | - Matthew Stead
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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8
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Verburg N, Koopman T, Yaqub MM, Hoekstra OS, Lammertsma AA, Barkhof F, Pouwels PJW, Reijneveld JC, Heimans JJ, Rozemuller AJM, Bruynzeel AME, Lagerwaard F, Vandertop WP, Boellaard R, Wesseling P, de Witt Hamer PC. Improved detection of diffuse glioma infiltration with imaging combinations: a diagnostic accuracy study. Neuro Oncol 2021; 22:412-422. [PMID: 31550353 PMCID: PMC7058442 DOI: 10.1093/neuonc/noz180] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/13/2019] [Indexed: 11/22/2022] Open
Abstract
Background Surgical resection and irradiation of diffuse glioma are guided by standard MRI: T2/fluid attenuated inversion recovery (FLAIR)–weighted MRI for non-enhancing and T1-weighted gadolinium-enhanced (T1G) MRI for enhancing gliomas. Amino acid PET has been suggested as the new standard. Imaging combinations may improve standard MRI and amino acid PET. The aim of the study was to determine the accuracy of imaging combinations to detect glioma infiltration. Methods We included 20 consecutive adults with newly diagnosed non-enhancing glioma (7 diffuse astrocytomas, isocitrate dehydrogenase [IDH] mutant; 1 oligodendroglioma, IDH mutant and 1p/19q codeleted; 1 glioblastoma IDH wildtype) or enhancing glioma (glioblastoma, 9 IDH wildtype and 2 IDH mutant). Standardized preoperative imaging (T1-, T2-, FLAIR-weighted, and T1G MRI, perfusion and diffusion MRI, MR spectroscopy and O-(2-[18F]-fluoroethyl)-L-tyrosine ([18F]FET) PET) was co-localized with multiregion stereotactic biopsies preceding resection. Tumor presence in the biopsies was assessed by 2 neuropathologists. Diagnostic accuracy was determined using receiver operating characteristic analysis. Results A total of 174 biopsies were obtained (63 from 9 non-enhancing and 111 from 11 enhancing gliomas), of which 129 contained tumor (50 from non-enhancing and 79 from enhancing gliomas). In enhancing gliomas, the combination of apparent diffusion coefficient (ADC) with [18F]FET PET (area under the curve [AUC], 95% CI: 0.89, 0.79‒0.99) detected tumor better than T1G MRI (0.56, 0.39‒0.72; P < 0.001) and [18F]FET PET (0.76, 0.66‒0.86; P = 0.001). In non-enhancing gliomas, no imaging combination detected tumor significantly better than standard MRI. FLAIR-weighted MRI had an AUC of 0.81 (0.65–0.98) compared with 0.69 (0.56–0.81; P = 0.019) for [18F]FET PET. Conclusion Combining ADC and [18F]FET PET detects glioma infiltration better than standard MRI and [18F]FET PET in enhancing gliomas, potentially enabling better guidance of local therapy.
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Affiliation(s)
- Niels Verburg
- Brain Tumor Center Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands.,Neurosurgical Center Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Thomas Koopman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Free University Medical Center (VUmc), Amsterdam, Netherlands
| | - Maqsood M Yaqub
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Free University Medical Center (VUmc), Amsterdam, Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Free University Medical Center (VUmc), Amsterdam, Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Free University Medical Center (VUmc), Amsterdam, Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Free University Medical Center (VUmc), Amsterdam, Netherlands.,University College London Institute of Neurology and Healthcare Engineering, London, UK
| | - Petra J W Pouwels
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Free University Medical Center (VUmc), Amsterdam, Netherlands
| | - Jaap C Reijneveld
- Brain Tumor Center Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands.,Department of Neurology, Amsterdam UMC, VUmc, Amsterdam, Netherlands
| | - Jan J Heimans
- Department of Neurology, Amsterdam UMC, VUmc, Amsterdam, Netherlands
| | | | | | - Frank Lagerwaard
- Department of Radiotherapy, Amsterdam UMC, VUmc, Amsterdam, Netherlands
| | - William P Vandertop
- Brain Tumor Center Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands.,Neurosurgical Center Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Free University Medical Center (VUmc), Amsterdam, Netherlands
| | - Pieter Wesseling
- Brain Tumor Center Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands.,Neurosurgical Center Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Department of Pathology, Amsterdam UMC, VUmc, Amsterdam, Netherlands.,Princess Máxima Center for Pediatric Oncology and Department of Pathology, UMC Utrecht, Utrecht, Netherlands
| | - Philip C de Witt Hamer
- Brain Tumor Center Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands.,Neurosurgical Center Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
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9
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Pistol C, Daneasa A, Ciurea J, Rasina A, Barborica A, Oane I, Mindruta I. Accuracy and Safety of Customized Stereotactic Fixtures for Stereoelectroencephalography in Pediatric Patients. Stereotact Funct Neurosurg 2020; 99:17-24. [PMID: 33227801 DOI: 10.1159/000510063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022]
Abstract
Stereoelectroencephalography (SEEG) in children with intractable epilepsy presents particular challenges. Their thin and partially ossified cranium, specifically in the temporal area, is prone to fracture while attaching stereotactic systems to the head or stabilizing the head in robot's field of action. Postponing SEEG in this special population of patients can have serious consequences, reducing their chances of becoming seizure-free and impacting their social and cognitive development. This study demonstrates the safety and accuracy offered by a frameless personalized 3D printed stereotactic implantation system for SEEG investigations in children under 4 years of age. SEEG was carried out in a 3-year-old patient with drug-resistant focal epilepsy, based on a right temporal-perisylvian epileptogenic zone hypothesis. Fifteen intracerebral electrodes were placed using a StarFix patient-customized stereotactic fixture. The median lateral entry point localization error of the electrodes was 0.90 mm, median lateral target point localization error was 1.86 mm, median target depth error was 0.83 mm, and median target point localization error was 1.96 mm. There were no perioperative complications. SEEG data led to a tailored right temporal-insular-opercular resection, with resulting seizure freedom (Engel IA). In conclusion, patient-customized stereotactic fixtures are a safe and accurate option for SEEG exploration in young children.
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Affiliation(s)
| | - Andrei Daneasa
- Neurology Department, University Emergency Hospital, Bucharest, Romania
| | - Jean Ciurea
- Neurosurgery Department, Bagdasar-Arseni Hospital, Bucharest, Romania
| | - Alin Rasina
- Neurosurgery Department, Bagdasar-Arseni Hospital, Bucharest, Romania
| | - Andrei Barborica
- Physics Department, University of Bucharest, Bucharest, Romania.,FHC Inc., Bowdoin, Maine, USA
| | - Irina Oane
- Neurology Department, University Emergency Hospital, Bucharest, Romania
| | - Ioana Mindruta
- Neurology Department, University Emergency Hospital, Bucharest, Romania, .,Neurology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,
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10
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Girgis F, Ovruchesky E, Kennedy J, Seyal M, Shahlaie K, Saez I. Superior accuracy and precision of SEEG electrode insertion with frame-based vs. frameless stereotaxy methods. Acta Neurochir (Wien) 2020; 162:2527-2532. [PMID: 32458403 DOI: 10.1007/s00701-020-04427-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stereotactic electroencephalography (SEEG) has largely become the preferred method for intracranial seizure localization in epileptic patients due to its low morbidity and minimally invasive approach. While robotic placement is gaining popularity, many centers continue to use manual frame-based and frameless methods for electrode insertion. However, it is unclear how these methods compare in regard to accuracy, precision, and safety. Here, we aim to compare frame-based insertion using a CRW frame (Integra®) and frameless insertion using the StealthStation™ S7 (Medtronic®) navigation system for common temporal SEEG targets. METHODS We retrospectively examined electrode targets in SEEG patients that were implanted with either frame-based or frameless methods at a level 4 epilepsy center. We focused on two commonly used targets: amygdala and hippocampal head. Stealth station software was used to merge pre-operative MR with post-operative CT images for each patient, and coordinates for each electrode tip were calculated in relation to the midcommissural point. These were compared to predetermined ideal coordinates in regard to error and directional bias. RESULTS A total of 81 SEEG electrodes were identified in 23 patients (40 amygdala and 41 hippocampal head). Eight of 45 electrodes (18%) placed with the frameless technique and 0 of 36 electrodes (0%) placed with the frame-based technique missed their target and were not clinically useful. The average Euclidean distance comparing actual to ideal electrode tip coordinates for frameless vs. frame-based techniques was 11.0 mm vs. 7.1 mm (p < 0.001) for the amygdala and 12.4 mm vs. 8.5 mm (p < 0.001) for the hippocampal head, respectively. There were no hemorrhages or clinical complications in either group. CONCLUSIONS Based on this series, frame-based SEEG insertion is significantly more accurate and precise and results in more clinically useful electrode contacts, compared to frameless insertion using a navigation guidance system. This has important implications for centers not currently using robotic insertion.
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Affiliation(s)
- Fady Girgis
- Department of Neurosurgery, University of California Davis School of Medicine, 4860 Y St. Suite 3740, Sacramento, 95817, USA.
| | - Eric Ovruchesky
- Department of Neurosurgery, University of California Davis School of Medicine, 4860 Y St. Suite 3740, Sacramento, 95817, USA
| | - Jeffrey Kennedy
- Department of Neurology, University of California Davis School of Medicine, 4860 Y St. Suite 3740, Sacramento, 95817, USA
| | - Masud Seyal
- Department of Neurology, University of California Davis School of Medicine, 4860 Y St. Suite 3740, Sacramento, 95817, USA
| | - Kiarash Shahlaie
- Department of Neurosurgery, University of California Davis School of Medicine, 4860 Y St. Suite 3740, Sacramento, 95817, USA
| | - Ignacio Saez
- Department of Neurosurgery, University of California Davis School of Medicine, 4860 Y St. Suite 3740, Sacramento, 95817, USA
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11
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De Barros A, Zaldivar-Jolissaint JF, Hoffmann D, Job-Chapron AS, Minotti L, Kahane P, De Schlichting E, Chabardès S. Indications, Techniques, and Outcomes of Robot-Assisted Insular Stereo-Electro-Encephalography: A Review. Front Neurol 2020; 11:1033. [PMID: 33041978 PMCID: PMC7527495 DOI: 10.3389/fneur.2020.01033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/07/2020] [Indexed: 01/04/2023] Open
Abstract
Stereo-electro-encephalography (SEEG) is an invasive, surgical, and electrophysiological method for three-dimensional registration and mapping of seizure activity in drug-resistant epilepsy. It allows the accurate analysis of spatio-temporal seizure activity by multiple intraparenchymal depth electrodes. The technique requires rigorous non-invasive pre-SEEG evaluation (clinical, video-EEG, and neuroimaging investigations) in order to plan the insertion of the SEEG electrodes with minimal risk and maximal recording accuracy. The resulting recordings are used to precisely define the surgical limits of resection of the epileptogenic zone in relation to adjacent eloquent structures. Since the initial description of the technique by Talairach and Bancaud in the 1950's, several techniques of electrode insertion have been used with accuracy and relatively few complications. In the last decade, robot-assisted surgery has emerged as a safe, accurate, and time-saving electrode insertion technique due to its unparalleled potential for orthogonal and oblique insertion trajectories, guided by rigorous computer-assisted planning. SEEG exploration of the insular cortex remains difficult due to its anatomical location, hidden by the temporal and frontoparietal opercula. Furthermore, the close vicinity of Sylvian vessels makes surgical electrode insertion challenging. Some epilepsy surgery teams remain cautious about insular exploration due to the potential of neurovascular injury. However, several authors have published encouraging results regarding the technique's accuracy and safety in both children and adults. We will review the indications, techniques, and outcomes of insular SEEG exploration with emphasis on robot-assisted implantation.
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Affiliation(s)
- Amaury De Barros
- Department of Neurosurgery, Toulouse University Hospital, Toulouse, France
| | | | - Dominique Hoffmann
- CHU Grenoble Alpes, Clinical University of Neurosurgery, Grenoble, France
| | | | - Lorella Minotti
- CHU Grenoble Alpes, Clinical University of Neurology, Grenoble, France
| | - Philippe Kahane
- CHU Grenoble Alpes, Clinical University of Neurology, Grenoble, France
| | | | - Stephan Chabardès
- CHU Grenoble Alpes, Clinical University of Neurosurgery, Grenoble, France
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12
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Granados A, Rodionov R, Vakharia V, McEvoy AW, Miserocchi A, O'Keeffe AG, Duncan JS, Sparks R, Ourselin S. Automated computation and analysis of accuracy metrics in stereoencephalography. J Neurosci Methods 2020; 340:108710. [PMID: 32339522 PMCID: PMC7456795 DOI: 10.1016/j.jneumeth.2020.108710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 11/25/2022]
Abstract
Automatic computation of SEEG accuracy metrics agree with those done manually. The choice of image to generate a scalp model has an effect on entry point metrics. Metrics have the lowest mean and variability when using an electrode bolt axis. Lateral shift deviation should include a measure of insertion depth error.
Background Implantation accuracy of electrodes during neurosurgical interventions is necessary to ensure safety and efficacy. Typically, metrics are computed by visual inspection which is tedious, prone to inter-/intra-observer variation, and difficult to replicate across sites. New Method We propose an automated approach for computing implantation metrics and investigate potential sources of error. We focus on accuracy metrics commonly reported in the literature to validate our approach against metrics computed manually including entry point (EP) and target point (TP) localisation errors and angle differences between planned and implanted trajectories in 15 patients with a total of 158 stereoelectroencephalography (SEEG) electrodes. We evaluate the effect of line-of-best-fit approaches, EP definition and lateral versus Euclidean distance on metrics to provide recommendations for reporting implantation accuracy metrics. Results We found no bias between manual and automated approaches for calculating accuracy metrics with limits of agreement of ±1 mm and ±1°. Automated metrics are robust to sources of errors including registration and electrode bending. We observe the highest error in EP deviations of μ = 0.25 mm when the post-implantation CT is used to define the point of entry. Comparison with Existing Method(s) We found no reports of automated approaches for quality assessment of SEEG electrode implantation. Neither the choice of metrics nor the possible errors that could occur have been investigated previously. Conclusions Our automated approach is useful to avoid human errors, unintentional bias and variation that may be introduced when manually computing metrics. Our work is relevant and timely to facilitate comparisons of studies reporting implantation accuracy.
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Affiliation(s)
- Alejandro Granados
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.
| | - Roman Rodionov
- National Hospital of Neurology and Neurosurgery, London, UK
| | - Vejay Vakharia
- National Hospital of Neurology and Neurosurgery, London, UK
| | | | | | | | - John S Duncan
- National Hospital of Neurology and Neurosurgery, London, UK; Dept of Clin and Experim Epilepsy, UCL Queen Square, Inst of Neurol, UK
| | - Rachel Sparks
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - Sébastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
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13
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Jiang C, Kong Z, Zhang Y, Liu S, Liu Z, Chen W, Liu P, Liu D, Wang Y, Lyu Y, Zhao D, Wang Y, You H, Feng F, Ma W. Conventional magnetic resonance imaging-based radiomic signature predicts telomerase reverse transcriptase promoter mutation status in grade II and III gliomas. Neuroradiology 2020; 62:803-813. [PMID: 32239241 DOI: 10.1007/s00234-020-02392-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/27/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Telomerase reverse transcriptase (TERT) promoter mutation status is an important biomarker for the precision diagnosis and prognosis prediction of lower grade glioma (LGG). This study aimed to construct a radiomic signature to noninvasively predict the TERT promoter status in LGGs. METHODS Eighty-three local patients with pathology-confirmed LGG were retrospectively included as a training cohort, and 33 patients from The Cancer Imaging Archive (TCIA) were used as for independent validation. Three types of regions of interest (ROIs), which covered the tumor, peri-tumoral area, and tumor plus peri-tumoral area, were delineated on three-dimensional contrast-enhanced T1 (3D-CE-T1)-weighted and T2-weighted images. One hundred seven shape, first-order, and texture radiomic features from each modality under each ROI were extracted and selected through least absolute shrinkage and selection operator. Radiomic signatures were constructed with multiple classifiers and evaluated using receiver operating characteristic (ROC) analysis. The tumors were also stratified according to IDH status. RESULTS Three radiomic signatures, namely, tumoral radiomic signature, tumoral plus peri-tumoral radiomic signature, and fusion radiomic signature, were built, all of which exhibited good accuracy and balanced sensitivity and specificity. The tumoral signature displayed the best performance, with area under the ROC curves (AUC) of 0.948 (0.903-0.993) in the training cohort and 0.827 (0.667-0.988) in the validation cohort. In the IDH subgroups, the AUCs of the tumoral signature ranged from 0.750 to 0.940. CONCLUSION The MRI-based radiomic signature is reliable for noninvasive evaluation of TERT promoter mutations in LGG regardless of the IDH status. The inclusion of peri-tumoral area did not significantly improve the performance.
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Affiliation(s)
- Chendan Jiang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ziren Kong
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiwei Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, China
| | - Sirui Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, China
| | - Zeyu Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, China
| | - Wenlin Chen
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Penghao Liu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Delin Liu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaning Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuelei Lyu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, China.,Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Dachun Zhao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, China.
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, China
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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14
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Kim LH, Feng AY, Ho AL, Parker JJ, Kumar KK, Chen KS, Grant GA, Henderson JM, Halpern CH. Robot-assisted versus manual navigated stereoelectroencephalography in adult medically-refractory epilepsy patients. Epilepsy Res 2019; 159:106253. [PMID: 31855826 DOI: 10.1016/j.eplepsyres.2019.106253] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/14/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) has experienced a recent growth in adoption for epileptogenic zone (EZ) localization. Advances in robotics have the potential to improve the efficiency and safety of this intracranial seizure monitoring method. We present our institutional experience employing robot-assisted SEEG and compare its operative efficiency, seizure reduction outcomes, and direct hospital costs with SEEG performed without robotic assistance using navigated stereotaxy. METHODS We retrospectively identified 50 consecutive adult SEEG cases at our institution in this IRB-approved study, of which 25 were navigated with image guidance (hereafter referred to as "navigated") (02/2014-10/2016) and 25 were robot-assisted (09/2016-12/2017). A thorough review of medical/surgical history and operative records with imaging and trajectory plans was done for each patient. Direct inpatient costs related to each technique were compared. RESULTS Most common seizure etiologies for patients undergoing navigated and robot-assisted SEEG included non-lesional and benign temporal lesions. Despite having a higher mean number of leads-per-patient (10.2 ± 3.5 versus 7.2 ± 2.6, P = 0.002), robot-assisted cases had a significantly shorter mean operative time than navigated cases (125.5±48.5 versus 173.4±84.3 min, P = 0.02). Comparison of robot-assisted cases over the study interval revealed no significant difference in mean operative time (136.4±51.4 min for the first ten cases versus 109.9±75.8 min for the last ten cases, P = 0.25) and estimated operative time-per-lead (13.4±6.0 min for the first ten cases versus 12.9±7.7 min for the last ten cases, P = 0.86). The mean depth, radial, target, and entry point errors for robot-assisted cases were 2.12±1.89, 1.66±1.58, 3.05±2.02 mm, and 1.39 ± 0.75 mm, respectively. The two techniques resulted in equivalent EZ localization rate (navigated 88 %, robot-assisted 96 %, P = 0.30). Common types of epilepsy surgery performed consisted of implantation of responsive neurostimulation (RNS) device (56 %), resection (19.1 %), and laser ablation (23.8 %) for navigated SEEG. For robot-assisted SEEG, either RNS implantation (68.2 %) or laser ablation (22.7 %) were performed or offered. A majority of navigated and robot-assisted patients who underwent epilepsy surgery achieved either Engel Class I (navigated 36.8 %, robot-assisted 31.6 %) or II (navigated 36.8 %, robot-assisted 15.8 %) outcome with no significant difference between the groups (P = 0.14). Direct hospital cost for robot-assisted SEEG was 10 % higher than non-robotic cases. CONCLUSION This single-institutional study suggests that robotic assistance can enhance efficiency of SEEG without compromising safety or precision when compared to image guidance only. Adoption of this technique with uniform safety and efficacy over a short period of time is feasible with favorable epilepsy outcomes.
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Affiliation(s)
- Lily H Kim
- Department of Neurosurgery, Stanford University School of Medicine, United States
| | - Austin Y Feng
- Department of Neurosurgery, Stanford University School of Medicine, United States
| | - Allen L Ho
- Department of Neurosurgery, Stanford University School of Medicine, United States
| | - Jonathon J Parker
- Department of Neurosurgery, Stanford University School of Medicine, United States
| | - Kevin K Kumar
- Department of Neurosurgery, Stanford University School of Medicine, United States
| | - Kevin S Chen
- Department of Neurosurgery, Stanford University School of Medicine, United States
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University School of Medicine, United States; Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital Stanford, United States
| | - Jaimie M Henderson
- Department of Neurosurgery, Stanford University School of Medicine, United States
| | - Casey H Halpern
- Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital Stanford, United States.
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15
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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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16
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Verburg N, Koopman T, Yaqub M, Hoekstra OS, Lammertsma AA, Schwarte LA, Barkhof F, Pouwels PJW, Heimans JJ, Reijneveld JC, Rozemuller AJM, Vandertop WP, Wesseling P, Boellaard R, de Witt Hamer PC. Direct comparison of [ 11C] choline and [ 18F] FET PET to detect glioma infiltration: a diagnostic accuracy study in eight patients. EJNMMI Res 2019; 9:57. [PMID: 31254208 PMCID: PMC6598977 DOI: 10.1186/s13550-019-0523-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/28/2019] [Indexed: 02/07/2023] Open
Abstract
Background Positron emission tomography (PET) is increasingly used to guide local treatment in glioma. The purpose of this study was a direct comparison of two potential tracers for detecting glioma infiltration, O-(2-[18F]-fluoroethyl)-l-tyrosine ([18F] FET) and [11C] choline. Methods Eight consecutive patients with newly diagnosed diffuse glioma underwent dynamic [11C] choline and [18F] FET PET scans. Preceding craniotomy, multiple stereotactic biopsies were obtained from regions inside and outside PET abnormalities. Biopsies were assessed independently for tumour presence by two neuropathologists. Imaging measurements were derived at the biopsy locations from 10 to 40 min [11C] choline and 20–40, 40–60 and 60–90 min [18F] FET intervals, as standardized uptake value (SUV) and tumour-to-brain ratio (TBR). Diagnostic accuracies of both tracers were compared using receiver operating characteristic analysis and generalized linear mixed modelling with consensus histopathological assessment as reference. Results Of the 74 biopsies, 54 (73%) contained tumour. [11C] choline SUV and [18F] FET SUV and TBR at all intervals were higher in tumour than in normal samples. For [18F] FET, the diagnostic accuracy of TBR was higher than that of SUV for intervals 40–60 min (area under the curve: 0.88 versus 0.81, p = 0.026) and 60–90 min (0.90 versus 0.81, p = 0.047). The diagnostic accuracy of [18F] FET TBR 60–90 min was higher than that of [11C] choline SUV 20–40 min (0.87 versus 0.67, p = 0.005). Conclusions [18F] FET was more accurate than [11C] choline for detecting glioma infiltration. Highest accuracy was found for [18F] FET TBR for the interval 60–90 min post-injection. Electronic supplementary material The online version of this article (10.1186/s13550-019-0523-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Niels Verburg
- Neurosurgical Center Amsterdam, Brain Tumour Center Amsterdam, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Thomas Koopman
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Otto S Hoekstra
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Lothar A Schwarte
- Department of Anaesthesiology, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,UCL institutes of Neurology & Healthcare Engineering, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | - Petra J W Pouwels
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jan J Heimans
- Department of Neurology, Brain Tumour Center Amsterdam, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology, Brain Tumour Center Amsterdam, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Annemieke J M Rozemuller
- Department of Pathology, Brain Tumour Center Amsterdam, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - William P Vandertop
- Neurosurgical Center Amsterdam, Brain Tumour Center Amsterdam, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Pieter Wesseling
- Department of Pathology, Brain Tumour Center Amsterdam, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Princess Máxima Center for Paediatric Oncology, and Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Ronald Boellaard
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Philip C de Witt Hamer
- Neurosurgical Center Amsterdam, Brain Tumour Center Amsterdam, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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17
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Rodionov R, O'Keeffe A, Nowell M, Rizzi M, Vakharia VN, Wykes V, Eriksson SH, Miserocchi A, McEvoy AW, Ourselin S, Duncan JS. Increasing the accuracy of 3D EEG implantations. J Neurosurg 2019; 133:35-42. [PMID: 31100733 DOI: 10.3171/2019.2.jns183313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The accuracy of stereoelectroencephalography (SEEG) electrode implantation is an important factor in maximizing its safety. The authors established a quality assurance (QA) process to aid advances in implantation accuracy. METHODS The accuracy of three consecutive modifications of a frameless implantation technique was quantified in three cohorts comprising 22, 8, and 23 consecutive patients. The modifications of the technique aimed to increase accuracy of the bolt placement. RESULTS The lateral shift of the axis of the implanted bolt at the level of the planned entry point was reduced from a mean of 3.0 ± 1.6 mm to 1.4 ± 0.8 mm. The lateral shift of the axis of the implanted bolt at the level of the planned target point was reduced from a mean of 3.8 ± 2.5 mm to 1.6 ± 0.9 mm. CONCLUSIONS This QA framework helped to isolate and quantify the factors introducing inaccuracy in SEEG implantation, and to monitor ongoing accuracy and the effect of technique modifications.
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Affiliation(s)
- Roman Rodionov
- 1UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London
- 2National Hospital for Neurology and Neurosurgery, London
- 3Epilepsy Society, Chalfont St. Peter, Buckinghamshire
| | - Aidan O'Keeffe
- 4Department of Statistical Science, University College London, United Kingdom
| | - Mark Nowell
- 1UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London
- 2National Hospital for Neurology and Neurosurgery, London
- 3Epilepsy Society, Chalfont St. Peter, Buckinghamshire
| | - Michele Rizzi
- 2National Hospital for Neurology and Neurosurgery, London
- 3Epilepsy Society, Chalfont St. Peter, Buckinghamshire
- 5"Claudio Munari" Epilepsy Surgery Centre, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Vejay N Vakharia
- 1UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London
- 2National Hospital for Neurology and Neurosurgery, London
- 3Epilepsy Society, Chalfont St. Peter, Buckinghamshire
| | - Victoria Wykes
- 2National Hospital for Neurology and Neurosurgery, London
| | - Sofia H Eriksson
- 1UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London
- 2National Hospital for Neurology and Neurosurgery, London
- 3Epilepsy Society, Chalfont St. Peter, Buckinghamshire
| | - Anna Miserocchi
- 1UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London
- 2National Hospital for Neurology and Neurosurgery, London
| | - Andrew W McEvoy
- 1UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London
- 2National Hospital for Neurology and Neurosurgery, London
| | - Sebastien Ourselin
- 6Centre for Medical Imaging Computing, University College London; and
- 7School of Biomedical Engineering and Imaging Sciences, Kings College London, United Kingdom
| | - John S Duncan
- 1UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London
- 2National Hospital for Neurology and Neurosurgery, London
- 3Epilepsy Society, Chalfont St. Peter, Buckinghamshire
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18
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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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19
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Ho AL, Feng AY, Kim LH, Pendharkar AV, Sussman ES, Halpern CH, Grant GA. Stereoelectroencephalography in children: a review. Neurosurg Focus 2018; 45:E7. [DOI: 10.3171/2018.6.focus18226] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Stereoelectroencephalography (SEEG) is an intracranial diagnostic measure that has grown in popularity in the United States as outcomes data have demonstrated its benefits and safety. The main uses of SEEG include 1) exploration of deep cortical/sulcal structures; 2) bilateral recordings; and 3) 3D mapping of epileptogenic zones. While SEEG has gradually been accepted for treatment in adults, there is less consensus on its utility in children. In this literature review, the authors seek to describe the current state of SEEG with a focus on the more recent technology-enabled surgical techniques and demonstrate its efficacy in the pediatric epilepsy population.
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Affiliation(s)
- Allen L. Ho
- 1Department of Neurosurgery, Stanford University School of Medicine; and
| | - Austin Y. Feng
- 1Department of Neurosurgery, Stanford University School of Medicine; and
| | - Lily H. Kim
- 1Department of Neurosurgery, Stanford University School of Medicine; and
| | | | - Eric S. Sussman
- 1Department of Neurosurgery, Stanford University School of Medicine; and
| | - Casey H. Halpern
- 1Department of Neurosurgery, Stanford University School of Medicine; and
| | - Gerald A. Grant
- 1Department of Neurosurgery, Stanford University School of Medicine; and
- 2Division of Pediatric Neurosurgery, Lucile Packard Children’s Hospital, Stanford, California
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20
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Yu H, Pistol C, Franklin R, Barborica A. Clinical Accuracy of Customized Stereotactic Fixtures for Stereoelectroencephalography. World Neurosurg 2018; 109:82-88. [DOI: 10.1016/j.wneu.2017.09.089] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 12/29/2022]
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21
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Dlaka D, Švaco M, Chudy D, Jerbić B, Šekoranja B, Šuligoj F, Vidaković J, Almahariq F, Romić D. Brain biopsy performed with the RONNA G3 system: a case study on using a novel robotic navigation device for stereotactic neurosurgery. Int J Med Robot 2017; 14. [PMID: 29232764 DOI: 10.1002/rcs.1884] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/09/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Robotic neuronavigation is becoming an important tool for neurosurgeons. We present a case study of a frameless stereotactic biopsy guided by the RONNA G3 robotic neuronavigation system. METHODS A 45 year-old patient with a history of vertigo, nausea and vomiting was diagnosed with multiple periventricular lesions. Neurological status was unremarkable. A frameless robotic biopsy of a brain lesion was performed. RESULTS Three tissue samples were obtained. There were no intraoperative or postoperative complications. Histological analysis showed a B-cell lymphoma. After merging the preoperative CT scan with the postoperative MRI and CT scans, the measured error between the planned and the postoperatively measured entry point was 2.24 mm and the measured error between the planned and postoperatively measured target point was 2.33 mm. CONCLUSIONS The RONNA G3 robotic system was used to navigate a Sedan brain biopsy needle to take tissue samples and could be a safe and precise tool for brain biopsy.
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Affiliation(s)
- Domagoj Dlaka
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Marko Švaco
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Darko Chudy
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Bojan Jerbić
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Bojan Šekoranja
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Filip Šuligoj
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Josip Vidaković
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Fadi Almahariq
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Dominik Romić
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
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22
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Verburg N, Pouwels PJW, Boellaard R, Barkhof F, Hoekstra OS, Reijneveld JC, Vandertop WP, Wesseling P, de Witt Hamer PC. Accurate Delineation of Glioma Infiltration by Advanced PET/MR Neuro-Imaging (FRONTIER Study): A Diagnostic Study Protocol. Neurosurgery 2017; 79:535-40. [PMID: 27479710 DOI: 10.1227/neu.0000000000001355] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Glioma imaging, used for diagnostics, treatment planning, and follow-up, is currently based on standard magnetic resonance imaging (MRI) modalities (T1 contrast-enhancement for gadolinium-enhancing gliomas and T2 fluid-attenuated inversion recovery hyperintensity for nonenhancing gliomas). The diagnostic accuracy of these techniques for the delineation of gliomas is suboptimal. OBJECTIVE To assess the diagnostic accuracy of advanced neuroimaging compared with standard MRI modalities for the detection of diffuse glioma infiltration within the brain. METHODS A monocenter, prospective, diagnostic observational study in adult patients with a newly diagnosed, diffuse infiltrative glioma undergoing resective glioma surgery. Forty patients will be recruited in 3 years. Advanced neuroimaging will be added to the standard preoperative MRI. Serial neuronavigated biopsies in and around the glioma boundaries, obtained immediately preceding resective surgery, will provide histopathologic and molecular characteristics of the regions of interest, enabling comparison with quantitative measurements in the imaging modalities at the same biopsy sites. DISCUSSION In this clinical study, we determine the diagnostic accuracy of advanced imaging in addition to standard MRI to delineate glioma. The results of our study can be valuable for the development of an improved standard imaging protocol for glioma treatment. EXPECTED OUTCOME We hypothesize that a combination of positron emission tomography, MR spectroscopy, and standard MRI will have a superior accuracy for glioma delineation compared with standard MRI alone. In addition, we anticipate that advanced imaging will correlate with the histopathologic and molecular characteristics of glioma. ABBREVIATIONS CHO, [11C-]CholineCRF, case report formsFET, [18F-]Fluoroethyl-tyrosineFLAIR, fluid-attenuated inversion recoveryMETC, Medical Ethical CommitteeMRS, magnetic resonance spectroscopyPET, positron emission tomographyVUmc, VU University Medical Center.
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Affiliation(s)
- Niels Verburg
- *Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands; ‡Department of Physics & Medical Technology, VU University Medical Center, Amsterdam, the Netherlands; §Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands; ¶Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands; ‖Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands; #Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
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23
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Sankey EW, Butler E, Sampson JH. Accuracy of Novel Computed Tomography–Guided Frameless Stereotactic Drilling and Catheter System in Human Cadavers. World Neurosurg 2017; 106:757-763. [DOI: 10.1016/j.wneu.2017.07.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
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24
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Budke M, Avecillas-Chasin JM, Villarejo F. Implantation of Depth Electrodes in Children Using VarioGuide® Frameless Navigation System: Technical Note. Oper Neurosurg (Hagerstown) 2017; 15:302-309. [DOI: 10.1093/ons/opx192] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/05/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Electrode placement in epilepsy surgery seeks to locate the sites of ictal onset and early propagation. An invasive diagnostic procedure, stereoelectroencephalography (SEEG) is usually implemented with frame-based methods that can be especially problematic in young children.
OBJECTIVE
To evaluate the feasibility and accuracy of a new technique for frameless SEEG in children using the VarioGuide® system (Brainlab AG, München, Germany).
METHODS
A frameless stereotactic navigation system was used to implant depth electrodes with percutaneous drilling and bolt insertion in pediatric patients with medically refractory epilepsy. Data on general demographic information of electrode implantation, duration, number, and complications were retrospectively collected. To determine the placement accuracy of the VarioGuide® frameless system, the mean Euclidean distances were calculated by comparing the preoperatively planned trajectories with the final electrode position observed on postoperative computed tomography scans.
RESULTS
From May 2011 to December 2015, 15 patients (8 males, 7 females; mean age: 8 yr, range: 3-16 yr) underwent SEEG depth electrode implantation of a total of 111 electrodes. The mean error measured by the Euclidean distance from the center of the entry point to the intended entry point was 3.64 ± 1.78 mm (range: 0.58-7.59 mm) and the tip of the electrode to the intended target was 2.96 ± 1.49 mm (range: 0.58-7.82 mm). There were no significant complications.
CONCLUSION
Depth electrodes can be placed safely and accurately in children using the VarioGuide® frameless stereotactic navigation system.
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Affiliation(s)
- Marcelo Budke
- Department of Pediatric Neurosurgery, Hospital Niño Jesus, Madrid, Spain
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25
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van der Loo LE, Schijns OEMG, Hoogland G, Colon AJ, Wagner GL, Dings JTA, Kubben PL. Methodology, outcome, safety and in vivo accuracy in traditional frame-based stereoelectroencephalography. Acta Neurochir (Wien) 2017; 159:1733-1746. [PMID: 28676892 PMCID: PMC5557874 DOI: 10.1007/s00701-017-3242-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/31/2017] [Indexed: 11/24/2022]
Abstract
Background Stereoelectroencephalography (SEEG) is an established diagnostic technique for the localization of the epileptogenic zone in drug-resistant epilepsy. In vivo accuracy of SEEG electrode positioning is of paramount importance since higher accuracy may lead to more precise resective surgery, better seizure outcome and reduction of complications. Objective To describe experiences with the SEEG technique in our comprehensive epilepsy center, to illustrate surgical methodology, to evaluate in vivo application accuracy and to consider the diagnostic yield of SEEG implantations. Methods All patients who underwent SEEG implantations between September 2008 and April 2016 were analyzed. Planned electrode trajectories were compared with post-implantation trajectories after fusion of pre- and postoperative imaging. Quantitative analysis of deviation using Euclidean distance and directional errors was performed. Explanatory variables for electrode accuracy were analyzed using linear regression modeling. The surgical methodology, procedure-related complications and diagnostic yield were reported. Results Seventy-six implantations were performed in 71 patients, and a total of 902 electrodes were implanted. Median entry and target point deviations were 1.54 mm and 2.93 mm. Several factors that predicted entry and target point accuracy were identified. The rate of major complications was 2.6%. SEEG led to surgical therapy of various modalities in 53 patients (69.7%). Conclusions This study demonstrated that entry and target point localization errors can be predicted by linear regression models, which can aid in identification of high-risk electrode trajectories and further enhancement of accuracy. SEEG is a reliable technique, as demonstrated by the high accuracy of conventional frame-based implantation methodology and the good diagnostic yield.
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26
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Abstract
Stereoelectroencephalography (SEEG) is a method for invasive study of patients with refractory epilepsy. Localization of the epileptogenic zone in SEEG relied on the hypothesis of anatomo-electro-clinical analysis limited by X-ray, analog electroencephalography (EEG), and seizure semiology in the 1950s. Modern neuroimaging studies and digital video-EEG have developed the hypothesis aiming at more precise localization of the epileptic network. Certain clinical scenarios favor SEEG over subdural EEG (SDEEG). SEEG can cover extensive areas of bilateral hemispheres with highly accurate sampling from sulcal areas and deep brain structures. A hybrid technique of SEEG and subdural strip electrode placement has been reported to overcome the SEEG limitations of poor functional mapping. Technological advances including acquisition of three-dimensional angiography and magnetic resonance image (MRI) in frameless conditions, advanced multimodal planning, and robot-assisted implantation have contributed to the accuracy and safety of electrode implantation in a simplified fashion. A recent meta-analysis of the safety of SEEG concluded the low value of the pooled prevalence for all complications. The complications of SEEG were significantly less than those of SDEEG. The removal of electrodes for SEEG was much simpler than for SDEEG and allowed sufficient time for data analysis, discussion, and consensus for both patients and physicians before the proceeding treatment. Furthermore, SEEG is applicable as a therapeutic alternative for deep-seated lesions, e.g., nodular heterotopia, in nonoperative epilepsies using SEEG-guided radiofrequency thermocoagulation. We review the SEEG method with technological advances for planning and implantation of electrodes. We highlight the indication and efficacy, advantages and disadvantages of SEEG compared with SDEEG.
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Affiliation(s)
- Koji Iida
- Department of Neurosurgery, Hiroshima University Hospital.,Epilepsy Center, Hiroshima University Hospital
| | - Hiroshi Otsubo
- Neurophysiology Laboratory, Division of Neurology, The Hospital for Sick Children
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27
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Vakharia VN, Sparks R, O’Keeffe AG, Rodionov R, Miserocchi A, McEvoy A, Ourselin S, Duncan J. Accuracy of intracranial electrode placement for stereoencephalography: A systematic review and meta-analysis. Epilepsia 2017; 58:921-932. [PMID: 28261785 PMCID: PMC6736669 DOI: 10.1111/epi.13713] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Stereoencephalography (SEEG) is a procedure in which electrodes are inserted into the brain to help define the epileptogenic zone. This is performed prior to definitive epilepsy surgery in patients with drug-resistant focal epilepsy when noninvasive data are inconclusive. The main risk of the procedure is hemorrhage, which occurs in 1-2% of patients. This may result from inaccurate electrode placement or a planned electrode damaging a blood vessel that was not detected on the preoperative vascular imaging. Proposed techniques include the use of a stereotactic frame, frameless image guidance systems, robotic guidance systems, and customized patient-specific fixtures. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a structured search of the PubMed, Embase, and Cochrane databases identified studies that involve the following: (1) SEEG placement as part of the presurgical workup in patients with (2) drug-resistant focal epilepsy for which (3) accuracy data have been provided. RESULTS Three hundred twenty-six publications were retrieved, of which 293 were screened following removal of duplicate and non-English-language studies. Following application of the inclusion and exclusion criteria, 15 studies were included in the qualitative and quantitative synthesis of the meta-analysis. Accuracies for SEEG electrode implantations have been combined using a random-effects analysis and stratified by technique. SIGNIFICANCE The published literature regarding accuracy of SEEG implantation techniques is limited. There are no prospective controlled clinical trials comparing different SEEG implantation techniques. Significant systematic heterogeneity exists between the identified studies, preventing any meaningful comparison between techniques. The recent introduction of robotic trajectory guidance systems has been suggested to provide a more accurate method of implantation, but supporting evidence is limited to class 3 only. It is important that new techniques are compared to the previous "gold-standard" through well-designed and methodologically sound studies before they are introduced into widespread clinical practice.
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Affiliation(s)
- Vejay N. Vakharia
- Department of Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Rachel Sparks
- Transitional Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Aidan G. O’Keeffe
- Department of Statistical Science, University College London, London, United Kingdom
| | - Roman Rodionov
- Department of Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Anna Miserocchi
- Department of Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Andrew McEvoy
- Department of Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Sebastien Ourselin
- Department of Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Transitional Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - John Duncan
- Department of Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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28
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Roessler K, Sommer B, Merkel A, Rampp S, Gollwitzer S, Hamer HM, Buchfelder M. A Frameless Stereotactic Implantation Technique for Depth Electrodes in Refractory Epilepsy Using Intraoperative Magnetic Resonance Imaging. World Neurosurg 2016; 94:206-210. [PMID: 27389940 DOI: 10.1016/j.wneu.2016.06.114] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 06/25/2016] [Accepted: 06/27/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Various complex techniques for depth electrode insertion in refractory epilepsy using preoperative imaging have been investigated. We evaluated a simple, accurate, cost-effective, and timesaving method using intraoperative magnetic resonance imaging (MRI). METHODS A neuronavigation-guided insertion tube attached to bone facilitated the placement of stereotactic percutaneous drill holes, bolt implantation, and frameless stereotactic insertion of depth electrodes. Image registration was carried out by head coil fiducials with trajectory planning and intraoperative electrode correction. RESULTS In 6 patients with refractory epilepsy (3 women and 3 men; mean age, 30.0 years; range, 20-37 years), 58 depth electrodes (9-11 per patient) were placed. The mean length of the inserted electrodes was 37.3 mm ± 8.8 (mean ± SD) (range, 22.1-84.4 mm). The overall target point accuracy was 3.2 mm ± 2.2 (range, 0-8.6 mm), which was significantly different from the overall entry point accuracy of 1.4 mm ± 1.2 (P < 0.0001). All electrodes functioned perfectly, enabling high-quality stereo-electroencephalography recordings over a period of 7.3 days ± 0.5 (range, 7-8 days). The mean implantation time for 9-11 electrodes per patient was 115 minutes ± 36.3 (range, 75-160 minutes; 12 minutes for 1 electrode on average) including the intraoperative MRI (T1 three-dimensional magnetization-prepared rapid acquisition gradient echo, T2, and diffusion tensor imaging). There was no hemorrhage, infection, or neurologic deficit related to the procedure. CONCLUSIONS Our frameless technique of depth electrode insertion using intraoperative MRI guidance is an accurate, reliable, cost-effective, and timesaving method for stereo-electroencephalography.
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Affiliation(s)
- Karl Roessler
- Department of Neurosurgery, Epilepsy Centre, University Hospital Erlangen, Erlangen, Germany.
| | - Björn Sommer
- Department of Neurosurgery, Epilepsy Centre, University Hospital Erlangen, Erlangen, Germany
| | - Andreas Merkel
- Department of Neurosurgery, Epilepsy Centre, University Hospital Erlangen, Erlangen, Germany
| | - Stefan Rampp
- Department of Neurosurgery, Epilepsy Centre, University Hospital Erlangen, Erlangen, Germany
| | - Stephanie Gollwitzer
- Department of Neurology, Epilepsy Centre, University Hospital Erlangen, Erlangen, Germany
| | - Hajo M Hamer
- Department of Neurology, Epilepsy Centre, University Hospital Erlangen, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Epilepsy Centre, University Hospital Erlangen, Erlangen, Germany
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