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Liu Q, Contreras A, Afaq MS, Yang W, Hsu DK, Russell M, Lyeth B, Zanto TP, Zhao M. Intensity-dependent gamma electrical stimulation regulates microglial activation, reduces beta-amyloid load, and facilitates memory in a mouse model of Alzheimer's disease. Cell Biosci 2023; 13:138. [PMID: 37507776 PMCID: PMC10386209 DOI: 10.1186/s13578-023-01085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Gamma sensory stimulation may reduce AD-specific pathology. Yet, the efficacy of alternating electrical current stimulation in animal models of AD is unknown, and prior research has not addressed intensity-dependent effects. METHODS The intensity-dependent effect of gamma electrical stimulation (GES) with a sinusoidal alternating current at 40 Hz on Aβ clearance and microglia modulation were assessed in 5xFAD mouse hippocampus and cortex, as well as the behavioral performance of the animals with the Morris Water Maze. RESULTS One hour of epidural GES delivered over a month significantly (1) reduced Aβ load in the AD brain, (2) increased microglia cell counts, decreased cell body size, increased length of cellular processes of the Iba1 + cells, and (3) improved behavioral performance (learning & memory). All these effects were most pronounced when a higher stimulation current was applied. CONCLUSION The efficacy of GES on the reduction of AD pathology and the intensity-dependent feature provide guidance for the development of this promising therapeutic approach.
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Affiliation(s)
- Qian Liu
- Institute for Regenerative Cures, Department of Ophthalmology & Vision Science, Department of Dermatology, University of California Davis, Sacramento, CA, 95817, USA
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology (SIAT), Chinese Academy of Sciences, Shenzhen, China
| | - Adam Contreras
- Institute for Regenerative Cures, Department of Ophthalmology & Vision Science, Department of Dermatology, University of California Davis, Sacramento, CA, 95817, USA
| | - Muhammad Shan Afaq
- Institute for Regenerative Cures, Department of Ophthalmology & Vision Science, Department of Dermatology, University of California Davis, Sacramento, CA, 95817, USA
| | - Weijian Yang
- Department of Electrical and Computer Engineering, University of California, Davis, CA, 95616, USA
| | - Daniel K Hsu
- Institute for Regenerative Cures, Department of Ophthalmology & Vision Science, Department of Dermatology, University of California Davis, Sacramento, CA, 95817, USA
| | - Michael Russell
- Institute for Regenerative Cures, Department of Ophthalmology & Vision Science, Department of Dermatology, University of California Davis, Sacramento, CA, 95817, USA
| | - Bruce Lyeth
- Department of Neurological Surgery, University of California, Davis, CA, 95616, USA
| | - Theodore P Zanto
- Neuroscape, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA.
| | - Min Zhao
- Institute for Regenerative Cures, Department of Ophthalmology & Vision Science, Department of Dermatology, University of California Davis, Sacramento, CA, 95817, USA.
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Clinical safety of intracranial EEG electrodes in MRI at 1.5 T and 3 T: a single-center experience and literature review. Neuroradiology 2021; 63:1669-1678. [PMID: 33543360 DOI: 10.1007/s00234-021-02661-7] [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: 10/31/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Intracranial electroencephalography (EEG) can be a critical part of presurgical evaluation for drug resistant epilepsy. With the increasing use of intracranial EEG, the safety of these electrodes in the magnetic resonance imaging (MRI) environment remains a concern, particularly at higher field strengths. However, no studies have reported the MRI safety experience of intracranial electrodes at 3 T. We report an MRI safety review of patients with intracranial electrodes at 1.5 and 3 T. METHODS One hundred and sixty-five consecutive admissions for intracranial EEG monitoring were reviewed. A total of 184 MRI scans were performed on 135 patients over 140 admissions. These included 118 structural MRI studies at 1.5 T and 66 functional MRI studies at 3 T. The magnetic resonance (MR) protocols avoided the use of high specific energy absorption rate sequences that could result in electrode heating. The intracranial implantations included 114 depth, 15 subdural, and 11 combined subdural and depth electrodes. Medical records were reviewed for patient-reported complications and radiologic complications related to these studies. Pre-implantation, post-implantation, and post-explantation imaging studies were reviewed for potential complications. RESULTS No adverse events or complications were seen during or after MRI scanning at 1.5 or 3 T apart from those attributed to electrode implantation. There was also no clinical or imaging evidence of worsening of pre-existing implantation-related complications after MR imaging. CONCLUSION No clinical or radiographic complications are seen when performing MRI scans at 1.5 or 3 T on patients with implanted intracranial EEG electrodes while avoiding high specific energy absorption rate sequences.
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Willems LM, Reif PS, Spyrantis A, Cattani A, Freiman TM, Seifert V, Wagner M, You SJ, Schubert-Bast S, Bauer S, Klein KM, Rosenow F, Strzelczyk A. Invasive EEG-electrodes in presurgical evaluation of epilepsies: Systematic analysis of implantation-, video-EEG-monitoring- and explantation-related complications, and review of literature. Epilepsy Behav 2019; 91:30-37. [PMID: 29907526 DOI: 10.1016/j.yebeh.2018.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stereoelectroencephalography (sEEG) is a diagnostic procedure for patients with refractory focal epilepsies that is performed to localize and define the epileptogenic zone. In contrast to grid electrodes, sEEG electrodes are implanted using minimal invasive operation techniques without large craniotomies. Previous studies provided good evidence that sEEG implantation is a safe and effective procedure; however, complications in asymptomatic patients after explantation may be underreported. The aim of this analysis was to systematically analyze clinical and imaging data following implantation and explantation. RESULTS We analyzed 18 consecutive patients (mean age: 30.5 years, range: 12-46; 61% female) undergoing invasive presurgical video-EEG monitoring via sEEG electrodes (n = 167 implanted electrodes) over a period of 2.5 years with robot-assisted implantation. There were no neurological deficits reported after implantation or explantation in any of the enrolled patients. Postimplantation imaging showed a minimal subclinical subarachnoid hemorrhage in one patient and further workup revealed a previously unknown factor VII deficiency. No injuries or status epilepticus occurred during video-EEG monitoring. In one patient, a seizure-related asymptomatic cross break of two fixation screws was found and led to revision surgery. Unspecific symptoms like headaches or low-grade fever were present in 10 of 18 (56%) patients during the first days of video-EEG monitoring and were transient. Postexplantation imaging showed asymptomatic and small bleedings close to four electrodes (2.8%). CONCLUSION Overall, sEEG is a safe and well-tolerated procedure. Systematic imaging after implantation and explantation helps to identify clinically silent complications of sEEG. In the literature, complication rates of up to 4.4% in sEEG and in 49.9% of subdural EEG are reported; however, systematic imaging after explantation was not performed throughout the studies, which may have led to underreporting of associated complications.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany.
| | - Philipp S Reif
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Andrea Spyrantis
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Adriano Cattani
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Marlies Wagner
- Department of Neuroradiology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Se-Jong You
- Department of Neuroradiology, Goethe-University, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Karl Martin Klein
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
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Stereotactic Electroencephalography Is a Safe Procedure, Including for Insular Implantations. World Neurosurg 2016; 99:353-361. [PMID: 28003163 DOI: 10.1016/j.wneu.2016.12.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/05/2016] [Accepted: 12/08/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND In some cases of drug-resistant focal epilepsy, noninvasive presurgical investigation may be insufficient to identify the ictal onset zone and the eloquent cortical areas. In such situations, invasive investigations are proposed using either stereotactic electroencephalography (SEEG) or subdural grid electrodes. Meta-analysis suggests that SEEG is safer than subdural grid electrodes, but insular implantation of SEEG electrodes has been thought to carry an additional risk of intraparenchymal hemorrhagic complications. Our objectives were to determine whether an insular SEEG trajectory is a risk factor for intracranial hematoma and to report the global safety of the procedure and provide some guidelines to prevent and detect complications. METHODS In a retrospective analysis of a surgical series of 525 consecutive procedures between 1995 and 2015, all electrodes were classified according to their insular or extrainsular trajectory. All complications were classified as major or minor according to their potential consequences regarding patient neurologic status. RESULTS Four intraparenchymal hematomas, all related to extrainsular electrodes (4/4974; 0.08%) were reported; no hematoma was found along insular electrodes (0/1042; 0%). There were 8 major complications (1.52%): 7 intracranial hematomas (1.33%) and 1 case of meningitis. Two patients had long-term neurologic impairment (0.38%), and 1 death (not directly related to the procedure) occurred (0.19%). Eleven minor complications (2.09%) were encountered, including broken electrode (1.52%), acute pneumocephalus (0.38%), and local cutaneous infection (0.19%). CONCLUSIONS SEEG is a safe procedure. Insular trajectories cannot be considered an additional risk of intracranial bleeding.
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Abstract
Nearly four decades after the invention of the N-localizer, its origin and history remain misunderstood. Some are unaware that a third-year medical student invented this technology. The following conspectus accurately chronicles the origin of the N-localizer, presents recently discovered evidence that documents its history, and corrects misconceptions related to its origin and early history.
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Mullin JP, Shriver M, Alomar S, Najm I, Bulacio J, Chauvel P, Gonzalez-Martinez J. Is SEEG safe? A systematic review and meta-analysis of stereo-electroencephalography-related complications. Epilepsia 2016; 57:386-401. [DOI: 10.1111/epi.13298] [Citation(s) in RCA: 250] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Jeffrey P. Mullin
- Department of Neurosurgery; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Michael Shriver
- Case Western Reserve University School of Medicine; Cleveland Ohio U.S.A
| | - Soha Alomar
- Department of Neurosurgery; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Imad Najm
- Case Western Reserve University School of Medicine; Cleveland Ohio U.S.A
| | - Juan Bulacio
- Case Western Reserve University School of Medicine; Cleveland Ohio U.S.A
| | - Patrick Chauvel
- Case Western Reserve University School of Medicine; Cleveland Ohio U.S.A
| | - Jorge Gonzalez-Martinez
- Department of Neurosurgery; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
- Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
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Abstract
Nearly four decades after the invention of the N-localizer, its origin and history remain misunderstood. Some are unaware that a third-year medical student invented this technology. The following conspectus accurately chronicles the origin and early history of the N-localizer and corrects some misconceptions related to both.
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Matsuo T, Kawai K, Uno T, Kunii N, Miyakawa N, Usami K, Kawasaki K, Hasegawa I, Saito N. Simultaneous Recording of Single-Neuron Activities and Broad-Area Intracranial Electroencephalography: Electrode Design and Implantation Procedure. Oper Neurosurg (Hagerstown) 2013; 73:ons146-54. [DOI: 10.1227/01.neu.0000430327.48387.e1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
There has been growing interest in clinical single-neuron recording to better understand epileptogenicity and brain function. It is crucial to compare this new information, single-neuronal activity, with that obtained from conventional intracranial electroencephalography during simultaneous recording. However, it is difficult to implant microwires and subdural electrodes during a single surgical operation because the stereotactic frame hampers flexible craniotomy.
OBJECTIVE:
To describe newly designed electrodes and surgical techniques for implanting them with subdural electrodes that enable simultaneous recording from hippocampal neurons and broad areas of the cortical surface.
METHODS:
We designed a depth electrode that does not protrude into the dura and pulsates naturally with the brain. The length and tract of the depth electrode were determined preoperatively between the lateral subiculum and the lateral surface of the temporal lobe. A frameless navigation system was used to insert the depth electrode. Surface grids and ventral strips were placed before and after the insertion of the depth electrodes, respectively. Finally, a microwire bundle was inserted into the lumen of the depth electrode. We evaluated the precision of implantation, the recording stability, and the recording rate with microwire electrodes.
RESULTS:
Depth-microwire electrodes were placed with a precision of 3.6 mm. The mean successful recording rate of single- or multiple-unit activity was 14.8%, which was maintained throughout the entire recording period.
CONCLUSION:
We achieved simultaneous implantation of microwires, depth electrodes, and broad-area subdural electrodes. Our method enabled simultaneous and stable recording of hippocampal single-neuron activities and multichannel intracranial electroencephalography.
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Affiliation(s)
- Takeshi Matsuo
- Department of Neurosurgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
- Department of Physiology, Niigata University School of Medicine, Niigata, Japan
| | - Kensuke Kawai
- Department of Neurosurgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Uno
- Department of Neurosurgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Naoto Kunii
- Department of Neurosurgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Naohisa Miyakawa
- Department of Physiology, Niigata University School of Medicine, Niigata, Japan
- Department of Ultrastructual Research, National Institute of Neuroscience, Kodaira, Japan
| | - Kenichi Usami
- Department of Neurosurgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Keisuke Kawasaki
- Department of Physiology, Niigata University School of Medicine, Niigata, Japan
| | - Isao Hasegawa
- Department of Physiology, Niigata University School of Medicine, Niigata, Japan
- Center for Transdisciplinary Research, Niigata University, Niigata, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
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De Momi E, Caborni C, Cardinale F, Castana L, Casaceli G, Cossu M, Antiga L, Ferrigno G. Automatic trajectory planner for StereoElectroEncephaloGraphy procedures: a retrospective study. IEEE Trans Biomed Eng 2012; 60:986-93. [PMID: 23221797 DOI: 10.1109/tbme.2012.2231681] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In StereoElectroEncephaloGraphy (SEEG) procedures, intracerebral electrodes are implanted in order to identify the epileptogenic zone in drug-resistant epileptic patients. This paper presents an automatic multitrajectory planner that computes the best trajectory in terms of distance from vessels and guiding screws angle, once the candidate entry and target regions are quickly and roughly defined. The planning process is designed also to spare some brain structures, such as cella media and trigone of the lateral ventricles and brain stem. The planner was retrospectively evaluated on 15 patients who had previously undergone SEEG investigation. Quantitative comparison was performed computing for each patient and for each electrode trajectory 1) the Euclidean distance from the closest vessel; 2) the trajectory incidence angle (guiding screws angle); and 3) the sulcality value. The automatic planner proved to satisfy the clinical requirements, planning safe trajectories in a clinical-compatible timeframe. Qualitative evaluation performed by three neurosurgeons showed that the automatically computed trajectories would have been accepted by them.
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Affiliation(s)
- Elena De Momi
- Dipartimento di Elettronica, Informatica e Bioingegneria, Politecnico di Milano, Milan 20133, Italy.
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Gross RE, Rowland NC, Sung EK, LaBorde DV, Suleiman SL. Anchoring depth electrodes for bedside removal: a "break-away" suturing technique for intracranial monitoring. Neurosurgery 2012; 71:52-6; discussion 56-7. [PMID: 22433201 DOI: 10.1227/neu.0b013e31825569c0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intracranial depth electrodes for epilepsy are easily dislodged during long-term monitoring unless adequately anchored, but a technique is not available that is both secure and allows easy explantation without reopening the incision. OBJECTIVE To describe a convenient and inexpensive method for anchoring depth electrodes that prevents migration and incidental pullout while allowing electrode removal at the bedside. METHODS An easily breakable suture (eg, MONOCRYL) is tied around both the depth electrode and a heavy nylon suture and anchored to a hole at the edge of the burr hole; the tails of both are tunneled together percutaneously. The "break-away" MONOCRYL suture effectively anchors the electrode for as long as needed. At the completion of the intracranial electroencephalography session, the 2 tails of the nylon suture are pulled to break their encompassing MONOCRYL anchor suture, thus freeing the depth electrode for easy removal. RESULTS The break-away depth electrode anchoring technique was used for 438 electrodes in 68 patients, followed by explantation of these and associated strip electrodes without reopening the incision. Only 1 electrode (0.2%) migrated spontaneously, and 3 depth electrodes (0.7%) fractured in 2 patients (2.9%) on explantation, necessitating open surgery to remove them in 1 of the patients (1.5%). CONCLUSION An easy and inexpensive anchoring configuration for depth electrodes is described that provides an effective and safe means of securing the electrodes while allowing easy explantation at the bedside.
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Affiliation(s)
- Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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Wray CD, Kraemer DL, Yang T, Poliachik SL, Ko AL, Poliakov A, Hebb AO, Novotny EJ, Ojemann JG. Freehand placement of depth electrodes using electromagnetic frameless stereotactic guidance. J Neurosurg Pediatr 2011; 8:464-7. [PMID: 22044370 DOI: 10.3171/2011.8.peds11143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The presurgical evaluation of patients with epilepsy often requires an intracranial study in which both subdural grid electrodes and depth electrodes are needed. Performing a craniotomy for grid placement with a stereotactic frame in place can be problematic, especially in young children, leading some surgeons to consider frameless stereotaxy for such surgery. The authors report on the use of a system that uses electromagnetic impulses to track the tip of the depth electrode. Ten pediatric patients with medically refractory focal lobar epilepsy required placement of both subdural grid and intraparenchymal depth electrodes to map seizure onset. Presurgical frameless stereotaxic targeting was performed using a commercially available electromagnetic image-guided system. Freehand depth electrode placement was then performed with intraoperative guidance using an electromagnetic system that provided imaging of the tip of the electrode, something that has not been possible using visually or sonically based systems. Accuracy of placement of depth electrodes within the deep structures of interest was confirmed postoperatively using CT and CT/MR imaging fusion. Depth electrodes were appropriately placed in all patients. Electromagnetic-tracking-based stereotactic targeting improves the accuracy of freehand placement of depth electrodes in patients with medically refractory epilepsy. The ability to track the electrode tip, rather than the electrode tail, is a major feature that enhances accuracy. Additional advantages of electromagnetic frameless guidance are discussed.
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Affiliation(s)
- Carter D Wray
- Departments of Neurology, University of Washington, Seattle, WA, USA.
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Ortler M, Sohm F, Eisner W, Bauer R, Dobesberger J, Trinka E, Widmann G, Bale R. Frame-Based vs Frameless Placement of Intrahippocampal Depth Electrodes in Patients With Refractory Epilepsy: A Comparative in Vivo (Application) Study. Neurosurgery 2011; 68:881-7; discussion 887. [DOI: 10.1227/neu.0b013e3182098e31] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
BACKGROUND:
Despite progress in imaging technologies, documentation of unifocal electrical excitability is pivotal in patient selection for epilepsy surgery.
OBJECTIVE:
To compare the application accuracy of the Vogele-Bale-Hohner system (VBH), a maxillary fixation system with an external fiducial frame permitting frameless stereotactic guidance, with that of conventional frame-based stereotaxy for placement of intrahippocampal depth electrodes (DEs) in patients with refractory epilepsy.
METHODS:
Retrospective study. Comparison of two patient cohorts with DEs implanted along the occipitotemporal axis (group A, VBH; group B, frame-based stereotaxy). In vivo accuracy (lateral target localization error [TLE]), determined postoperatively by measuring the normal distance between virtual target and real electrode position at the tip and at 4cm from the tip, number of electrode contacts within the target structure, and diagnostic quality of electroencephalogram recordings were compared.
RESULTS:
Seventeen DEs (A, 6 electrodes, 60 contacts; B, 11 electrodes, 90 contacts) were placed. electroencephalogram recordings via DEs supported further treatment decisions in all patients. TLE was 2.433 ± 0.977 mm (SD) (95% confidence interval [CI], 1.715-3.214 mm) (A) and 1.803 ± 0.392 mm (SD) (95% CI,1.511-2.195 mm) (B) (P = .185). Maximal error was 4 mm (A) and 3.2 mm (B). TLE 4 cm from the tip was 2.166 ± 2.188 mm (SD) (95% CI,0.438-3.916 mm) (A) and 1.372 ± 0.548 mm (SD) (95% CI,1.049-1.695 mm) (B) (P = .39). Maximal error 4 cm from the tip was 6.4 mm (A) and 2.14 mm (B). On average, 7 (A) and 5 (B) electrode contacts were placed in the target region.
CONCLUSION:
The VBH and frame-based systems offer similar in vivo accuracy for intrahippocampal DE placement. With frame-based methods, accuracy is higher but the number of contacts per side is lower. This does not translate to clinically important differences.
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Affiliation(s)
- Martin Ortler
- Clinical Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria
| | - Florian Sohm
- Clinical Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria
| | - Wilhelm Eisner
- Clinical Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria
| | - Richard Bauer
- Clinical Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria
| | - Judith Dobesberger
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Eugen Trinka
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Gerlig Widmann
- Interdisciplinary Stereotactic Intervention and Planning Laboratory, Clinical Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
| | - Reto Bale
- Interdisciplinary Stereotactic Intervention and Planning Laboratory, Clinical Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
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Shenai MB, Ross DA, Sagher O. The use of multiplanar trajectory planning in the stereotactic placement of depth electrodes. Neurosurgery 2007; 60:272-6; discussion 276. [PMID: 17415163 DOI: 10.1227/01.neu.0000255390.92785.a4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the value of multiplanar reconstruction software in trajectory planning for depth electrode insertion in medically refractory epilepsy. METHODS A series of 29 patients undergoing frame-based hippocampal depth electrode insertion were identified. In 19 patients, preoperative trajectory planning was conducted in axial, coronal, and sagittal planes using standard-axis software. In 10 patients, preoperative trajectory planning was conducted with multiplanar reconstruction software. Postoperative magnetic resonance imaging scans were evaluated to study the quality of insertion. Target accuracy was assessed by measuring the mean shortest distance to strictly defined hippocampal borders in the coronal plane ("coronal deviation"). Additionally, the number of electrode contacts placed within the amygdalohippocampal structure was assessed. RESULTS With the use of multiplanar reconstruction software, there was a statistically insignificant increase in coronal deviation (standard-axis software group, 0.09 +/- 0.50 mm; multiplanar reconstruction group, 0.37 +/- 1.16 mm). However, the use of multiplanar planning strategies resulted in approximately one additional electrode contact inserted in the amygdalohippocampal structure (standard-axis software group, 3.42 +/- 0.89; multiplanar reconstruction group, 4.36 +/- 0.93; P < 0.01). CONCLUSION The use of reconstructed planes in preoperative trajectory planning allows for the insertion of additional electrode contacts within the target structure.
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Affiliation(s)
- Mahesh B Shenai
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Mehta AD, Labar D, Dean A, Harden C, Hosain S, Pak J, Marks D, Schwartz TH. Frameless stereotactic placement of depth electrodes in epilepsy surgery. J Neurosurg 2005; 102:1040-5. [PMID: 16028763 DOI: 10.3171/jns.2005.102.6.1040] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. Depth electrodes are useful in the identification of deep epileptogenic foci. Computerized tomography—magnetic resonance (CT/MR)— and angiography-guided frame-based techniques are safe and accurate but require four-point skull fixation that limits cranial access for the placement of additional grids and strips. The authors investigated the viability and accuracy of placing depth electrodes by using a commercially available frameless system.
Methods. A slotted, custom-designed adapter was built to interface with the StealthStation Guide Frame-DT and 960-525 StealthFighter. The Cranial Navigation software was used to plan the trajectory and entry site based on preoperative spoiled gradient MR imaging studies. Forty-one depth electrodes were placed in 51 targets in 20 patients. Thirty-one of these electrodes were inserted through the temporal neocortex following craniotomy and placement of subdural grids, whereas 10 were placed through burr holes. All electrodes had contact either within (71%) or touching (29%) the target, 50 of which (98%) provided adequate recordings. Although the mean distance of the distal electrode contact from the intended target was 3.1 ± 0.5 mm, the mean distance to the edge of the anatomical structure was 0.4 ± 0.9 mm. Placement via the laterotemporal approach was significantly (p < 0.001) more accurate than that via the occipitotemporal approach. No complication occurred.
Conclusions. Depth electrodes can be placed safely and accurately by using a commercially available frameless stereotactic navigation system and a custom-made adapter. Depth electrode placement to record ictal onsets during epilepsy surgery only requires the contacts to touch rather than to reside within the intended structure. The laterotemporal approach is a more accurate method of placing electrodes than is the occipitotemporal one, likely due to the increased distance from the entry point to the target.
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Affiliation(s)
- Ashesh D Mehta
- Department of Neurological Surgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York 10021, USA
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Kuboki T, Clark GT, Akhtari M, Sutherling WW. A newly developed removable dental device for fused 3-D MRI/MEG Imaging. Oral Radiol 1999. [DOI: 10.1007/bf02489756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Van Roost D, Solymosi L, Schramm J, van Oosterwyck B, Elger CE. Depth electrode implantation in the length axis of the hippocampus for the presurgical evaluation of medial temporal lobe epilepsy: a computed tomography-based stereotactic insertion technique and its accuracy. Neurosurgery 1998; 43:819-26; discussion 826-7. [PMID: 9766309 DOI: 10.1097/00006123-199810000-00058] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE An individualized computed tomography-based stereotactic technique for the longitudinal insertion of intrahippocampal electrodes is presented and its accuracy described. METHODS The technique makes use of one well reproducible target in the hippocampal head and of the approximate inclination of the anteroposterior length axis of the hippocampus, for which the orbital floor is taken as an auxiliary landmark. It was used in 141 patients with medically intractable complex partial seizures. In 106 patients, magnetic resonance imaging (MRI) was available for assessment of implantation accuracy. Each of the 212 electrodes was plotted on topographic drawings and its goodness of fit rated. RESULTS Whereas hippocampal head and body were hit by 97 and 96% of the electrodes, respectively, the amygdala was hit by only 75% of the electrodes and mainly at its basal margin. For 93% of the electrodes, the inclination in a sagittal plane corresponded exactly to that of the hippocampus. The implantation morbidity amounted to 5.7%, whereas permanent neurological deficit occurred in one (0.7%) of the 141 patients. CONCLUSION This computed tomography-based protocol proved to be reliable and hence can be considered as an adequate alternative to MRI-based stereotactic implantation if MRI is not available or if a single MRI-based stereotactic set-up is unreliable because of intolerable distortions.
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Affiliation(s)
- D Van Roost
- Department of Neurosurgery, University of Bonn, Germany
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Ross DA, Brunberg JA, Drury I, Henry TR. Intracerebral depth electrode monitoring in partial epilepsy: the morbidity and efficacy of placement using magnetic resonance image-guided stereotactic surgery. Neurosurgery 1996; 39:327-33; discussion 333-4. [PMID: 8832670 DOI: 10.1097/00006123-199608000-00018] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To determine the indications for, efficacy of, and safety of depth electrode placement using magnetic resonance imaging (MRI)-guided stereotactic surgery in patients with intractable epilepsy. METHODS We analyzed retrospectively the results of depth electrode usage in 50 consecutive patients at the University of Michigan Hospitals studied in the years 1991 through 1994, using MRI-guided stereotactic implantation, in conjunction with simultaneous subdural strip electrode recordings. RESULTS There were no deaths, no infections, and no new neurological deficits. One small subdural hematoma adjacent to a subdural strip electrode was evacuated to prevent interference with ictal recording. Two cylindrical subdural electrodes were found to be intraparenchymal, as revealed by postoperative MRI, and were removed. One patient was unintentionally left alone briefly, and he pulled out the electrodes while confused postictally, requiring a subsequent operation for replacement. Ictal onset zones were successfully localized in 47 patients. CONCLUSION We have found intracerebral electrode placement to be as safe as subdural strip electrode placement and have found combined depth and strip electrode monitoring to be highly effective in localizing the onset zones of complex partial seizures. Intracranial monitoring was particularly useful in the detection of a single ictal onset zone in the absence of neuroimaging abnormality and in the definitive diagnosis of bilateral independent ictal onset zones in the temporal lobe epilepsy syndrome. The specific technical aspects of the procedure that contribute to a successful outcome are reviewed. A comparison with earlier reported series suggests that MRI-guided stereotaxy and pial inspection may reduce complications of depth electrode placement.
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Affiliation(s)
- D A Ross
- Department of Surgery (Section of Neurosurgery), University of Michigan Medical Center, Ann Arbor, USA
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