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Baumgartner ME, Galligan K, Kennedy BC. Advanced approaches in Pediatric Epilepsy surgery. Curr Probl Pediatr Adolesc Health Care 2024:101575. [PMID: 38395641 DOI: 10.1016/j.cppeds.2024.101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
While recent technological advancements are reshaping the landscape of surgical epilepsy management, the established techniques of resective and disconnective surgeries guided by electrographic monitoring remain the workhorse interventions for the management of refractory seizures and have the highest likelihood of achieving complete seizure resolution. Here we discuss examples of recent developments in surgical approaches and techniques for resective and disconnective surgeries with discussion of their indications and potential advantages.
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Affiliation(s)
| | - Kathleen Galligan
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin C Kennedy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
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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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Vasconcellos FDN, Almeida T, Müller Fiedler A, Fountain H, Santos Piedade G, Monaco BA, Jagid J, Cordeiro JG. Robotic-Assisted Stereoelectroencephalography: A Systematic Review and Meta-Analysis of Safety, Outcomes, and Precision in Refractory Epilepsy Patients. Cureus 2023; 15:e47675. [PMID: 38021558 PMCID: PMC10672406 DOI: 10.7759/cureus.47675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Robotic assistance in stereoelectroencephalography (SEEG) holds promising potential for enhancing accuracy, efficiency, and safety during electrode placement and surgical procedures. This systematic review and meta-analysis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and International Prospective Register of Systematic Reviews (PROSPERO) registration, delves into the latest advancements and implications of robotic systems in SEEG, while meticulously evaluating outcomes and safety measures. Among 855 patients suffering from medication-refractory epilepsy who underwent SEEG in 29 studies, averaging 24.6 years in age, the most prevalent robots employed were robotic surgical assistant (ROSA) (450 patients), Neuromate (207), Sinovation (140), and ISys1 (58). A total of 8,184 electrodes were successfully implanted, with an average operative time of 157.2 minutes per procedure and 15.1 minutes per electrode, resulting in an overall mean operative time of 157.7 minutes across all studies. Notably, the mean target point error (TPE) stood at 2.13 mm, the mean entry point error (EPE) at 1.48 mm, and postoperative complications occurred in 7.69% of robotically assisted (RA) SEEG cases (60), with 85% of these complications being asymptomatic. This comprehensive analysis underscores the safety and efficacy of RA-SEEG in patients with medication-refractory epilepsy, characterized by low complication rates, reduced operative time, and precise electrode placement, supporting its widespread adoption in clinical practice, with no discernible differences noted among the various robotic systems.
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Affiliation(s)
| | - Timoteo Almeida
- Department of Neurosurgery, University of Miami, Miami, USA
- Department of Radiation Oncology, University of Miami, Miami, USA
| | | | - Hayes Fountain
- Department of Neurosurgery, University of Miami, Miami, USA
| | | | - Bernardo A Monaco
- Department of Neurological Surgery, University of Miami, Miami, USA
- Department of Neurological Surgery, CDF (Clinica de Dor e Funcional), Sao Paulo, BRA
- Department of Neurological Surgery, University of Sao Paulo, Sao Paulo, BRA
| | - Jonathan Jagid
- Department of Neurological Surgery, University of Miami, Miami, USA
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Williams A, Ordaz JD, Budnick H, Desai VR, Tailor Bmbch J, Raskin JS. Accuracy of Depth Electrodes is Not Time-Dependent in Robot-Assisted Stereoelectroencephalography in a Pediatric Population. Oper Neurosurg (Hagerstown) 2023; 25:269-277. [PMID: 37219595 DOI: 10.1227/ons.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/21/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Robot-assisted stereoelectroencephalography (sEEG) is steadily supplanting traditional frameless and frame-based modalities for minimally invasive depth electrode placement in epilepsy workup. Accuracy rates similar to gold-standard frame-based techniques have been achieved, with improved operative efficiency. Limitations in cranial fixation and placement of trajectories in pediatric patients are believed to contribute to a time-dependent accumulation of stereotactic error. Thus, we aim to study the impact of time as a marker of cumulative stereotactic error during robotic sEEG. METHODS All patients between October 2018 and June 2022 who underwent robotic sEEG were included. Radial errors at entry and target points as well as depth and Euclidean distance errors were collected for each electrode, excluding those with errors over 10 mm. Target point errors were standardized by planned trajectory length. ANOVA and error rates over time were analyzed using GraphPad Prism 9. RESULTS Forty-four patients met inclusion criteria for a total of 539 trajectories. Number of electrodes placed ranged from 6 to 22. Average root mean squared error was 0.45 ± 0.12 mm. Average entry, target, depth, and Euclidean distance errors were 1.12 ± 0.41 mm, 1.46 ± 0.44 mm, -1.06 ± 1.43 mm, and 3.01 ± 0.71 mm, respectively. There was no significant increased error with each sequential electrode placed (entry error P -value = .54, target error P -value = .13, depth error P -value = .22, Euclidean distance P -value = .27). CONCLUSION No decremental accuracy over time was observed. This may be secondary to our workflow which prioritizes oblique and longer trajectories first and then into less error-prone trajectories. Further study on the effect of level of training may reveal a novel difference in error rates.
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Affiliation(s)
- Ari Williams
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Josue D Ordaz
- Department of Neurological Surgery, Section of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hailey Budnick
- Department of Neurological Surgery, Section of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Virendra R Desai
- Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Jignesh Tailor Bmbch
- Department of Neurological Surgery, Section of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeffrey S Raskin
- Department of Neurosurgery, Section of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
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A comparison between robot-guided and stereotactic frame-based stereoelectroencephalography (SEEG) electrode implantation for drug-resistant epilepsy. J Robot Surg 2022; 17:1013-1020. [DOI: 10.1007/s11701-022-01504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
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Phan TN, Prakash KJ, Elliott RJS, Pasupuleti A, Gaillard WD, Keating RF, Oluigbo CO. Virtual reality-based 3-dimensional localization of stereotactic EEG (SEEG) depth electrodes and related brain anatomy in pediatric epilepsy surgery. Childs Nerv Syst 2022; 38:537-546. [PMID: 34718866 DOI: 10.1007/s00381-021-05403-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The increasing use of stereoelectroencephalography (SEEG) in the USA and the need for three-dimensional (3D) appreciation of complex spatial relationships between implanted stereotactic EEG depth electrodes and surrounding brain and cerebral vasculature are a challenge to clinicians who are used to two-dimensional (2D) appreciation of cortical anatomy having been traditionally trained on 2D radiologic imaging. Virtual reality and its 3D renderings have grown increasingly common in the multifaceted practice of neurosurgery. However, there exists a paucity in the literature regarding this emerging technology in its utilization of epilepsy surgery. METHODS An IRB-approved, single-center retrospective study identifying all SEEG pediatric patients in which virtual reality was applied was observed. RESULTS Of the 46 patients identified who underwent an SEEG procedure, 43.5% (20/46) had a 3D rendering (3DR) of their SEEG depth electrodes. All 3DRs were used during patient-family education and discussion among the Epilepsy multidisciplinary team meetings, while 35% (7/20) were used during neuronavigation in surgery. Three successful representative cases of its application were presented. DISCUSSION Our institution's experience regarding virtual reality in the 3D representation of SEEG depth electrodes and the application to pre-surgical planning, patient-family education, multidisciplinary communication, and intraoperative neuronavigation demonstrate its applicability in comprehensive epilepsy patient care.
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Affiliation(s)
- Tiffany N Phan
- Department of Neurosurgery, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | | | - Ross-Jordon S Elliott
- Department of Neurological Surgery, George Washington University, Washington, DC, USA
| | - Archana Pasupuleti
- Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - William D Gaillard
- Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - Robert F Keating
- Department of Neurosurgery, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
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Stereoelectroencephalography in the very young: Case report. Epilepsy Behav Rep 2022; 19:100552. [PMID: 35664664 PMCID: PMC9157455 DOI: 10.1016/j.ebr.2022.100552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/05/2022] [Accepted: 05/14/2022] [Indexed: 11/22/2022] Open
Abstract
To the best of our knowledge this is the youngest reported patient implanted with SEEG. Accurate and safe SEEG surgery may be feasible in patients as young as 17 months-old. Robotic SEEG with standard tools may be effectively used in this very young population.
Stereoelectroencephalography (SEEG) is an increasingly popular invasive monitoring approach to epilepsy surgery in patients with drug-resistant epilepsies. The technique allows a three-dimensional definition of the epileptogenic zones (EZ) in the brain. It has been shown to be safe and effective in adults and older children but has been used sparingly in children less than two years old due to concerns about pin fixation in thin bone, registration accuracy, and bolt security. As such, most current series of pediatric invasive EEG explorations do not include young participants, and, when they do, SEEG is often not utilized for these patients. Recent national survey data further suggests SEEG is infrequently utilized in very young patients. We present a novel case of SEEG used to localize the EZ in a 17-month-old patient with thin cranial bone, an open fontanelle, and severe drug-resistant epilepsy due to tuberous sclerosis complex (TSC), with excellent accuracy, surgical results, and seizure remission.
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Cho K, Chang WS, Kim HD, Chang JW, Kim SH, Lee JS, Kang HC. Robot-Assisted Stereoelectroencephalography for Pediatric Epilepsy Surgery: The First Case in Korea. ANNALS OF CHILD NEUROLOGY 2021. [DOI: 10.26815/acn.2021.00430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Guglielmi G, Eschbach KL, Alexander AL. Smaller Knife, Fewer Seizures? Recent Advances in Minimally Invasive Techniques in Pediatric Epilepsy Surgery. Semin Pediatr Neurol 2021; 39:100913. [PMID: 34620456 DOI: 10.1016/j.spen.2021.100913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 02/02/2023]
Abstract
Children with drug-resistant epilepsy are at high risk for developmental delay, increased mortality, psychiatric comorbidities, and requiring assistance with activities of daily living. Despite the advent of new and effective pharmacologic therapies, about one in 5 children will develop drug-resistant epilepsy, and most of these children continue to have seizures despite trials of other medication. Epilepsy surgery is often a safe and effective option which may offer seizure freedom or at least a significant reduction in seizure burden in many children. However, despite published evidence of safety and efficacy, epilepsy surgery remains underutilized in the pediatric population. Patient and family fears about the risks of surgery may contribute to this gap. Less invasive surgical techniques may be more palatable to children with epilepsy and their caregivers. In this review, we present recent advances in minimally invasive techniques for the surgical treatment of epilepsy as well as intriguing possibilities for the future. We describe the indications for, benefits of, and limits to minimally-invasive techniques including Stereo-encephalography, laser interstitial thermal ablation, deep brain stimulation, focused ultrasound, stereo-encephalography-guided radiofrequency ablation, endoscopic disconnections, and responsive neurostimulation.
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Affiliation(s)
- Gina Guglielmi
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO
| | - Krista L Eschbach
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO
| | - Allyson L Alexander
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO.
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The UK experience of stereoelectroencephalography in children: An analysis of factors predicting the identification of a seizure-onset zone and subsequent seizure freedom. Epilepsia 2021; 62:1883-1896. [PMID: 34165813 DOI: 10.1111/epi.16954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) is being used more frequently in the pre-surgical evaluation of children with focal epilepsy. It has been shown to be safe in children, but there are no multicenter studies assessing the rates and factors associated with the identification of a putative seizure-onset zone (SOZ) and subsequent seizure freedom following SEEG-guided epilepsy surgery. METHODS Multicenter retrospective cohort study of all children undergoing SEEG at six of seven UK Children's Epilepsy Surgery Service centers from 2014 to 2019. Demographics, noninvasive evaluation, SEEG, and operative factors were analyzed to identify variables associated with the identification of a putative SOZ and subsequent seizure freedom following SEEG-guided epilepsy surgery. RESULTS One hundred thirty-five patients underwent 139 SEEG explorations using a total of 1767 electrodes. A putative SOZ was identified in 117 patients (85.7%); odds of successfully finding an SOZ were 6.4 times greater for non-motor seizures compared to motor seizures (p = 0.02) and 3.6 times more if four or more seizures were recorded during SEEG (p = 0.03). Of 100 patients undergoing surgical treatment, 47 (47.0%) had an Engel class I outcome at a median follow-up of 1.3 years; the only factor associated with outcome was indication for SEEG (p = 0.03); an indication of "recurrence following surgery/treatment" had a 5.9 times lower odds of achieving seizure freedom (p = 0.002) compared to the "lesion negative" cohort, whereas other indications ("lesion positive, define extent," "lesion positive, discordant noninvasive investigations" and "multiple lesions") were not statistically significantly different. SIGNIFICANCE This large nationally representative cohort illustrates that SEEG-guided surgery can still achieve high rates of seizure freedom. Seizure semiology and the number of seizures recorded during SEEG are important factors in the identification of a putative SOZ, and the indication for SEEG is an important factor in postoperative outcomes.
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Triano MJ, Schupper AJ, Ghatan S, Panov F. Hemorrhage Rates After Implantation and Explantation of Stereotactic Electroencephalography: Reevaluating Patients' Risk. World Neurosurg 2021; 151:e100-e108. [PMID: 33819712 DOI: 10.1016/j.wneu.2021.03.139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (sEEG), despite its established usefulness, has not been thoroughly evaluated for its adverse events profile. In this study, hemorrhage rates were evaluated both per patient and per lead placed not only in the immediate postoperative period, but also over the course of admission and after explantation when available. METHODS This is a single-center retrospective study of pediatric and adult patients undergoing sEEG lead placement at a large urban hospital. All available postoperative imaging was reviewed for the presence of hemorrhage, including any imaging occurring throughout admission as well as within 1 month of lead explantation. Age and number of leads placed per procedure were compared using an unpaired t test assuming unequal variance. RESULTS A total of 1855 leads were placed in 147 cases. The mean age was 30.4 ±15.0 and the male/female ratio was 47:53. 9 leads (0.49%) in 9 cases (6.12%) were involved with postimplantation hemorrhage occurring on postoperative day 0.44 on average. Postexplantation imaging was available for 45 cases. Seven leads (1.40%) in 7 cases (15.56%) were involved with postexplantation hemorrhage occurring on average on postoperative day 1.42. There was a significant difference in mean age between patients with postexplantation hemorrhage versus control (45.0 vs. 32.2; P = 0.0277). No cases of hemorrhage required surgical intervention and no patients had permanent neurologic deficit. CONCLUSIONS Hemorrhage after sEEG lead implantation and explantation may be more common than previously reported. Consistent postexplantation imaging may be of clinical benefit in detecting hemorrhage that precludes patients from immediate discharge, particularly in older patients.
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Affiliation(s)
- Matthew J Triano
- Department of Neurosurgery, Georgetown University School of Medicine Washington, D.C., USA
| | - Alexander J Schupper
- Department of Neurosurgery, Mount Sinai Hospital System, New York, New York, USA
| | - Saadi Ghatan
- Department of Neurosurgery, Mount Sinai Hospital System, New York, New York, USA
| | - Fedor Panov
- Department of Neurosurgery, Mount Sinai Hospital System, New York, New York, USA.
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Kalbhenn T, Cloppenborg T, Coras R, Fauser S, Hagemann A, Omaimen H, Polster T, Yasin H, Woermann FG, Bien CG, Simon M. Stereotactic depth electrode placement surgery in paediatric and adult patients with the Neuromate robotic device: Accuracy, complications and epileptological results. Seizure 2021; 87:81-87. [PMID: 33730649 DOI: 10.1016/j.seizure.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/04/2021] [Accepted: 03/05/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The number of patients requiring depth electrode implantation for invasive video EEG diagnostics increases in most epilepsy centres. Here we report on our institutional experience with frameless robot-assisted stereotactic placement of intracerebral depth electrodes using the Neuromate® stereotactic robot-system. METHODS We identified all patients who had undergone robot-assisted stereotactic placement of intracerebral depth electrodes for invasive extra-operative epilepsy monitoring between September 2013 and March 2020. We studied technical (placement) and diagnostic accuracy of the robot-assisted procedure, associated surgical complications and procedural time requirements. RESULTS We evaluated a total of 464 depth electrodes implanted in 74 patients (mean 6 per patient, range 1-12). There were 27 children and 47 adults (age range: 3.6-64.6 yrs.). The mean entry and target point errors were 1.82±1.15 and 1.98±1.05 mm. Target and entry point errors were significantly higher in paediatric vs. adult patients and for electrodes targeting the temporo-mesial region. There were no clinically relevant haemorrhages and no infectious complications. Mean time for the placement of one electrode was 37±14 min and surgery time per electrode decreased with the number of electrodes placed. 55 patients (74.3%) underwent definitive surgical treatment. 36/51 (70.1%) patients followed for >12 months or until seizure recurrence became seizure-free (ILAE I). CONCLUSION Frameless robot-guided stereotactic placement of depth electrodes with the Neuromate® stereotactic robot-system is safe and feasible even in very young children, with good in vivo accuracy and high diagnostic precision. The surgical workflow is time-efficient and further improves with increasing numbers of implanted electrodes.
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Affiliation(s)
- Thilo Kalbhenn
- Department of Neurosurgery - Epilepsy surgery, Evangelisches Klinikum Bethel, Kantensiek 11, 33617 Bielefeld, Germany.
| | - Thomas Cloppenborg
- Epilepsy Centre, Krankenhaus Mara, Maraweg 17-21, 33617 Bielefeld, Germany
| | - Roland Coras
- Department of Neuropathology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Susanne Fauser
- Epilepsy Centre, Krankenhaus Mara, Maraweg 17-21, 33617 Bielefeld, Germany
| | - Anne Hagemann
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany
| | - Hassan Omaimen
- Institute of diagnostic and interventional Neuroradiology, Evangelisches Klinikum Bethel, Burgsteig 13, 33617 Bielefeld, Germany
| | - Tilman Polster
- Epilepsy Centre, Krankenhaus Mara, Maraweg 17-21, 33617 Bielefeld, Germany
| | - Hamzah Yasin
- Department of Neurosurgery - Epilepsy surgery, Evangelisches Klinikum Bethel, Kantensiek 11, 33617 Bielefeld, Germany
| | | | - Christian G Bien
- Epilepsy Centre, Krankenhaus Mara, Maraweg 17-21, 33617 Bielefeld, Germany; Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany
| | - Matthias Simon
- Department of Neurosurgery - Epilepsy surgery, Evangelisches Klinikum Bethel, Kantensiek 11, 33617 Bielefeld, Germany
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Kim LH, Parker JJ, Ho AL, Feng AY, Kumar KK, Chen KS, Ojukwu DI, Shuer LM, Grant GA, Graber KD, Halpern CH. Contemporaneous evaluation of patient experience, surgical strategy, and seizure outcomes in patients undergoing stereoelectroencephalography or subdural electrode monitoring. Epilepsia 2020; 62:74-84. [PMID: 33236777 DOI: 10.1111/epi.16762] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Intracranial electrographic localization of the seizure onset zone (SOZ) can guide surgical approaches for medically refractory epilepsy patients, especially when the presurgical workup is discordant or functional cortical mapping is required. Minimally invasive stereotactic placement of depth electrodes, stereoelectroencephalography (SEEG), has garnered increasing use, but limited data exist to evaluate its postoperative outcomes in the context of the contemporaneous availability of both SEEG and subdural electrode (SDE) monitoring. We aimed to assess the patient experience, surgical intervention, and seizure outcomes associated with these two epileptic focus mapping techniques during a period of rapid adoption of neuromodulatory and ablative epilepsy treatments. METHODS We retrospectively reviewed 66 consecutive adult intracranial electrode monitoring cases at our institution between 2014 and 2017. Monitoring was performed with either SEEG (n = 47) or SDEs (n = 19). RESULTS Both groups had high rates of SOZ identification (SEEG 91.5%, SDE 88.2%, P = .69). The majority of patients achieved Engel class I (SEEG 29.3%, SDE 35.3%) or II outcomes (SEEG 31.7%, SDE 29.4%) after epilepsy surgery, with no significant difference between groups (P = .79). SEEG patients reported lower median pain scores (P = .03) and required less narcotic pain medication (median = 94.5 vs 594.6 milligram morphine equivalents, P = .0003). Both groups had low rates of symptomatic hemorrhage (SEEG 0%, SDE 5.3%, P = .11). On multivariate logistic regression, undergoing resection or ablation (vs responsive neurostimulation/vagus nerve stimulation) was the only significant independent predictor of a favorable outcome (adjusted odds ratio = 25.4, 95% confidence interval = 3.48-185.7, P = .001). SIGNIFICANCE Although both SEEG and SDE monitoring result in favorable seizure control, SEEG has the advantage of superior pain control, decreased narcotic usage, and lack of routine need for intensive care unit stay. Despite a heterogenous collection of epileptic semiologies, seizure outcome was associated with the therapeutic surgical modality and not the intracranial monitoring technique. The potential for an improved postoperative experience makes SEEG a promising method for intracranial electrode monitoring.
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Affiliation(s)
- Lily H Kim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathon J Parker
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Allen L Ho
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Austin Y Feng
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kevin K Kumar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kevin S Chen
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Disep I Ojukwu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Lawrence M Shuer
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.,Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Kevin D Graber
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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14
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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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15
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Liu Y, Chen G, Chen J, Zhou J, Su L, Zhao T, Zhang G. Individualized stereoelectroencephalography evaluation and navigated resection in medically refractory pediatric epilepsy. Epilepsy Behav 2020; 112:107398. [PMID: 32891888 DOI: 10.1016/j.yebeh.2020.107398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 11/25/2022]
Abstract
Pediatric patients frequently require invasive exploration with intracranial electrodes to achieve high-resolution delineation of the epileptogenic zones (EZ). We intend to discuss the efficacy and safety of stereoelectroencephalophraphy (SEEG) monitoring in pediatric patients with difficulty to localize the EZ. We retrospectively analyzed presurgical findings, SEEG data, resections, and outcomes of a series of 72 consecutive pediatric patients (<18 yrs) who had medically refractory epilepsy and received SEEG recording between January 2015 and September 2019. There were 20 girls and 52 boys with a mean age of 10.13 ± 4.11 years old (range: 1.8-18 years). Twenty-seven patients (37.5%) had nonlesional magnetic resonance imagings (MRIs). In total, 744 electrodes were implanted for an average of 10.33 ± 2.53 (range: 3-18) electrodes per patient. Twenty-eight explorations were unilateral (17 left and 11 right), and 44 explorations were bilateral (12 of which was predominately one side). The average monitoring period in days for the SEEG was 8.99 ± 5.79 (range: 3-25) days. The EZ could be located in 67 (94.4%) patients for the initial implantation according to SEEG monitoring. Lobectomy was performed in 12 patients (17.9%), of those anterior temporal lobectomy (ATL) was performed in 8 cases (11.9%) and insular plus was 2 cases (3.0%), multilobectomy resections in 15 cases (22.4%), tailored cortical resections in 37 cases (55.2%), and corpus callosotomy plus in 2 cases (3.0%). The average follow-up was 18.1 ± 7.53 months (range: 6-54). Forty-three of 67 patients (64.2%) were Engel class I, 12 patients (17.9%) were Engel class II, 10 patients (14.9%) were Engel class III, and an additional 2 patients (3.0%) were Engel class IV. In the SEEG implantation series, no child experienced serious or permanent morbidity. One patient (1.4%) experienced symptomatic intracranial hemorrhage (ICH), and 3 patients (4.2%) experienced asymptomatic ICH. There were no postimplantation infections or other postoperative complications associated with the SEEG. Several common complications related to resection surgery were included in this series with zero mortality. Of the 6 patients in whom we performed a second surgery, 4 of them subsequently became seizure-free (66.7%) after undergoing the second resection with SEEG evaluation. Stereoelectroencephalophraphy is a safe and efficient methodology to identify the EZ in particularly complex cases of focal medically refractory epilepsy for pediatric patients, even in infancy and early childhood. Seizure outcomes of SEEG-guided resection surgery are desirable. We recommend SEEG evaluations and even a more aggressive resection in certain pediatric patients who failed initial resection with realistic chances to benefit from reoperation.
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Affiliation(s)
- Yaoling Liu
- Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China
| | - Guoqiang Chen
- Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China
| | - Jianwei Chen
- Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China
| | - Junjian Zhou
- Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China
| | - Lanmei Su
- Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China
| | - Tong Zhao
- Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China
| | - Guangming Zhang
- Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China.
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16
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Harary M, Cosgrove GR. Jean Talairach: a cerebral cartographer. Neurosurg Focus 2020; 47:E12. [PMID: 31473671 DOI: 10.3171/2019.6.focus19320] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/06/2019] [Indexed: 11/06/2022]
Abstract
Although French psychiatrist-turned-neurosurgeon Jean Talairach (1911-2007) is perhaps best known for the stereotaxic atlas he produced with Pierre Tournoux and Gábor Szikla, he has left his mark on most aspects of modern stereotactic and functional neurosurgery. In the field of psychosurgery, he expressed critique of the practice of prefrontal lobotomy and subsequently was the first to describe the more selective approach using stereotactic bilateral anterior capsulotomy. Turning his attention to stereotaxy, Talairach spearheaded the team at Hôpital Sainte-Anne in the construction of novel stereotaxic apparatus. Cadaveric investigation using these tools and methods resulted in the first human stereotaxic atlas where the use of the anterior and posterior commissures as intracranial reference points was established. This work revolutionized the approach to cerebral localization as well as leading to the development of numerous novel stereotactic interventions by the Sainte-Anne team, including tumor biopsy, interstitial irradiation, thermal ablation, and endonasal procedures. Together with epileptologist Jean Bancaud, Talairach invented the field of stereo-electroencephalography and developed a robust scientific methodology for the assessment and treatment of epilepsy. In this article the authors review Talairach's career trajectory in its historical context and in view of its impact on modern stereotactic and functional neurosurgery.
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Affiliation(s)
- Maya Harary
- 2Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - G Rees Cosgrove
- 1Harvard Medical School and.,2Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
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Bollard L, Moore E, Paff R. Epilepsy Surgery: A Paediatric Perspective. AUSTRALASIAN JOURNAL OF NEUROSCIENCE 2020. [DOI: 10.21307/ajon-2020-007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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18
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Chen Y, Huang T, Sun Y, Liao J, Cao D, Li L, Xiang K, Lin C, Li C, Chen Q. Surface-Based Registration of MR Scan versus Refined Anatomy-Based Registration of CT Scan: Effect on the Accuracy of SEEG Electrodes Implantation Performed in Prone Position under Frameless Neuronavigation. Stereotact Funct Neurosurg 2020; 98:73-79. [PMID: 32036377 DOI: 10.1159/000505713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/31/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Stereoelectroencephalography (SEEG) refers to a commonly used diagnostic procedure to localise and define the epileptogenic zone of refractory focal epilepsies, by means of minimally invasive operation techniques without large craniotomies. OBJECTIVE This study aimed to investigate the influence of different registration methods on the accuracy of SEEG electrode implantation under neuronavigation for paediatric patients with refractory epilepsy. METHODS The clinical data of 18 paediatric patients with refractory epilepsy were retrospectively analysed. The SEEG electrodes were implanted under optical neuronavigation while the patients were in the prone position. Patients were divided into two groups on the basis of the surface-based registration of MR scan method and refined anatomy-based registration of CT scan. Registration time, accuracy, and the differences between electrode placement and preoperative planned position were analysed. RESULTS Thirty-six electrodes in 7 patients were placed under surface-based registration of MR scan, and 45 electrodes in 11 patients were placed under refined anatomy-based registration of CT scan. The registration time of surface-based registration of MR scan and refined anatomy-based registration of CT scan was 45 ± 12 min and 10 ± 4 min. In addition, the mean registration error, the error of insertion point, and target error were 3.6 ± 0.7 mm, 2.7 ± 0.7 mm, and 3.1 ± 0.5 mm in the surface-based registration of MR scan group, and 1.1 ± 0.3 mm, 1.5 ± 0.5 mm, and 2.2 ± 0.6 mm in the refined anatomy-based registration of CT scan group. The differences between the two registration methods were statistically significant. CONCLUSIONS The refined anatomy-based registration of CT scan method can improve the registration efficiency and electrode placement accuracy, and thereby can be considered as the preferred registration method in the application of SEEG electrode implantation under neuronavigation for treatment of paediatric intractable epilepsy.
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Affiliation(s)
- Yan Chen
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Tieshuan Huang
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Yang Sun
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Jianxiang Liao
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Dezhi Cao
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Lin Li
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Kui Xiang
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Chun Lin
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Cong Li
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Qian Chen
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China,
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19
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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: 29] [Impact Index Per Article: 5.8] [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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20
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Alexander H, Fayed I, Oluigbo CO. Rigid Cranial Fixation for Robot-Assisted Stereoelectroencephalography in Toddlers: Technical Considerations. Oper Neurosurg (Hagerstown) 2019; 18:614-620. [DOI: 10.1093/ons/opz247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/31/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Stereoelectroencephalography (sEEG) using depth electrodes has become a mainstay of pediatric epilepsy surgery. This technique relies on rigid cranial fixation using skull pins, which forms the basis for accurate stereotactic navigation. The use of cranial fixation pins poses the threat of traumatic skull injuries in young children because of inadequate cranial bone thickness.
OBJECTIVE
To describe a rigid cranial fixation technique involving the integrated Gel Head Ring from the DORO QR3 multipurpose skull clamp set (Pro Med Instruments) with superimposed pin fixation in children below the age of 36 mo undergoing sEEG.
METHODS
Patients were placed in the supine position and the head was fixed using a DORO skull clamp with 3 pediatric cranial pins. The head was supported on the integrated Gel Head Ring, and a pin pressure of 20 pounds was applied. The DORO skull clamp set was then attached to the ROSA neurosurgical robot support telescopic arm for stereotactic navigation.
RESULTS
We present an illustrative series of 2 patients below the age of 3 yr with medically refractory epilepsy who underwent sEEG using our modified cranial fixation technique. Head position and reference registration were stable throughout the surgeries. Postoperative volumetric computed tomography scans of the head showed accurate placement of sEEG depth electrodes and did not reveal any fractures or epidural hematoma. No other complications related to cranial fixation were noted.
CONCLUSION
Concurrent use of rigid and nonrigid cranial fixation using the DORO skull clamp set provides safe and effective cranial fixation in infants and toddlers undergoing sEEG.
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Affiliation(s)
- Hepzibha Alexander
- Children's National Medical Center, Department of Neurosurgery, School of Medicine, Georgetown University, Washington, District of Columbia
| | - Islam Fayed
- Children's National Medical Center, Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Chima O Oluigbo
- Children's National Medical Center, Department of Neurosurgery, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
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Tomlinson SB, Buch VP, Armstrong D, Kennedy BC. Stereoelectroencephalography in Pediatric Epilepsy Surgery. J Korean Neurosurg Soc 2019; 62:302-312. [PMID: 31085956 PMCID: PMC6514312 DOI: 10.3340/jkns.2019.0015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 12/25/2022] Open
Abstract
Stereoelectroencephalography (SEEG) is an invasive technique used during the surgical management of medically refractory epilepsy. The utility of SEEG rests in its ability to survey the three-dimensional organization of the epileptogenic zone as well as nearby eloquent cortices. Once concentrated to specialized centers in Europe and Canada, the SEEG methodology has gained worldwide popularity due to its favorable morbidity profile, superior coverage of deep structures, and ability to perform multilobar explorations without the need for craniotomy. This rapid shift in practice represents both a challenge and an opportunity for pediatric neurosurgeons familiar with the subdural grid approach. The purpose of this review is to discuss the indications, technique, and safety of long-term SEEG monitoring in children. In addition to reviewing the conceptual and technical points of the diagnostic evaluation, attention will also be given to SEEG-based interventions (e.g., radiofrequency thermo-coagulation).
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Affiliation(s)
- Samuel B Tomlinson
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Vivek P Buch
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Dallas Armstrong
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin C Kennedy
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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