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Guzzi G, Ricciuti RA, Della Torre A, Lo Turco E, Lavano A, Longhini F, La Torre D. Intraoperative Neurophysiological Monitoring in Neurosurgery. J Clin Med 2024; 13:2966. [PMID: 38792507 PMCID: PMC11122101 DOI: 10.3390/jcm13102966] [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: 04/16/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Intraoperative neurophysiological monitoring (IONM) is a crucial advancement in neurosurgery, enhancing procedural safety and precision. This technique involves continuous real-time assessment of neurophysiological signals, aiding surgeons in timely interventions to protect neural structures. In addition to inherent limitations, IONM necessitates a detailed anesthetic plan for accurate signal recording. Given the growing importance of IONM in neurosurgery, we conducted a narrative review including the most relevant studies about the modalities and their application in different fields of neurosurgery. In particular, this review provides insights for all physicians and healthcare professionals unfamiliar with IONM, elucidating commonly used techniques in neurosurgery. In particular, it discusses the roles of IONM in various neurosurgical settings such as tumoral brain resection, neurovascular surgery, epilepsy surgery, spinal surgery, and peripheral nerve surgery. Furthermore, it offers an overview of the anesthesiologic strategies and limitations of techniques essential for the effective implementation of IONM.
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Affiliation(s)
- Giusy Guzzi
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
| | | | - Attilio Della Torre
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Erica Lo Turco
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Angelo Lavano
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
- Anesthesia and Intensive Care Unit, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
| | - Domenico La Torre
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
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Suresh H, Mithani K, Brar K, Yan H, Strantzas S, Vandenberk M, Sharma R, Yau I, Go C, Pang E, Kerr E, Ochi A, Otsubo H, Jain P, Donner E, Snead OC, Ibrahim GM. Brainstem Associated Somatosensory Evoked Potentials and Response to Vagus Nerve Stimulation: An Investigation of the Vagus Afferent Network. Front Neurol 2022; 12:768539. [PMID: 35250790 PMCID: PMC8895499 DOI: 10.3389/fneur.2021.768539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/22/2021] [Indexed: 12/05/2022] Open
Abstract
Despite decades of clinical usage, selection of patients with drug resistant epilepsy who are most likely to benefit from vagus nerve stimulation (VNS) remains a challenge. The mechanism of action of VNS is dependent upon afferent brainstem circuitry, which comprises a critical component of the Vagus Afferent Network (VagAN). To evaluate the association between brainstem afferent circuitry and seizure response, we retrospectively collected intraoperative data from sub-cortical recordings of somatosensory evoked potentials (SSEP) in 7 children with focal drug resistant epilepsy who had failed epilepsy surgery and subsequently underwent VNS. Using multivariate linear regression, we demonstrate a robust negative association between SSEP amplitude (p < 0.01), and seizure reduction. There was no association between SSEP latency and seizure outcomes. Our findings provide novel insights into the mechanism of VNS and inform our understanding of the importance of brainstem afferent circuitry within the VagAN for seizure responsiveness following VNS.
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Affiliation(s)
- Hrishikesh Suresh
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Karim Mithani
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Karanbir Brar
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Han Yan
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Samuel Strantzas
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mike Vandenberk
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Roy Sharma
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ivanna Yau
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christina Go
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Pang
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Kerr
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ayako Ochi
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Puneet Jain
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Donner
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - O. Carter Snead
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - George M. Ibrahim
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- *Correspondence: George M. Ibrahim
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Jaber M, Shawahna R, Abu-Issa M, Radwan F, Dweik M. Anesthesia considerations for patients with epilepsy: Findings of a qualitative study in the Palestinian practice. Epilepsy Behav 2021; 123:108278. [PMID: 34492543 DOI: 10.1016/j.yebeh.2021.108278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/11/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This qualitative exploratory study was conducted to explore how anesthesiologists in Palestine provide perioperative care for patients with epilepsy and how they account for the unique challenges relevant to epilepsy while planning perioperative care for patients with epilepsy. METHODS This study was conducted in an explorative qualitative design. Purposive and snowball sampling approaches were used to recruit the study participants. Qualitative semi-structured in-depth interviews were conducted with anesthesiologists (n = 10) and a neurologist (n = 1). The qualitative data collected in this study were thematically analyzed using the interpretive description methodology to generate themes, subthemes, and patterns. RESULTS Three major themes emerged from the collected qualitative data with a total of 18 subthemes. The 3 themes were: 1) considerations/challenges while assessing patients, 2) anesthetic considerations, and 3) recovery considerations. Lack of epilepsy-specific assessment and anesthesia protocols, underuse of neurology referral services, and lack of neuromonitoring were identified. CONCLUSION Findings of this study highlighted the need to develop specific anesthesia protocols for patients with epilepsy. Anesthesiologists and planners of perioperative care should improve collection of patient information and assessment methods, ensure control over seizures, reduce triggers of seizures, and improve patient monitoring approaches. Findings of this study might be used to inform anesthesiologists and decision makers in professional groups, patient advocacy groups, and healthcare authorities to benchmark and improve anesthesia care and services offered to patients with epilepsy. More studies are still needed to quantitatively assess the quality of anesthesia care and services provided to patients with epilepsy.
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Affiliation(s)
- Mohammad Jaber
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah National University Hospital, An-Najah National University, Nablus, Palestine.
| | - Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine
| | - Majd Abu-Issa
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Faris Radwan
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mohammad Dweik
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Skyrman S, Lai M, Edström E, Burström G, Förander P, Homan R, Kor F, Holthuizen R, Hendriks BHW, Persson O, Elmi-Terander A. Augmented reality navigation for cranial biopsy and external ventricular drain insertion. Neurosurg Focus 2021; 51:E7. [PMID: 34333469 DOI: 10.3171/2021.5.focus20813] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the accuracy (deviation from the target or intended path) and efficacy (insertion time) of an augmented reality surgical navigation (ARSN) system for insertion of biopsy needles and external ventricular drains (EVDs), two common neurosurgical procedures that require high precision. METHODS The hybrid operating room-based ARSN system, comprising a robotic C-arm with intraoperative cone-beam CT (CBCT) and integrated video tracking of the patient and instruments using nonobtrusive adhesive optical markers, was used. A 3D-printed skull phantom with a realistic gelatinous brain model containing air-filled ventricles and 2-mm spherical biopsy targets was obtained. After initial CBCT acquisition for target registration and planning, ARSN was used for 30 cranial biopsies and 10 EVD insertions. Needle positions were verified by CBCT. RESULTS The mean accuracy of the biopsy needle insertions (n = 30) was 0.8 mm ± 0.43 mm. The median path length was 39 mm (range 16-104 mm) and did not correlate to accuracy (p = 0.15). The median device insertion time was 149 seconds (range 87-233 seconds). The mean accuracy for the EVD insertions (n = 10) was 2.9 mm ± 0.8 mm at the tip with a 0.7° ± 0.5° angular deviation compared with the planned path, and the median insertion time was 188 seconds (range 135-400 seconds). CONCLUSIONS This study demonstrated that ARSN can be used for navigation of percutaneous cranial biopsies and EVDs with high accuracy and efficacy.
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Affiliation(s)
- Simon Skyrman
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marco Lai
- 2Philips Research, High Tech Campus 34, Eindhoven.,3Eindhoven University of Technology (TU/e), Eindhoven
| | - Erik Edström
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Burström
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Petter Förander
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Flip Kor
- 5Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | - Benno H W Hendriks
- 2Philips Research, High Tech Campus 34, Eindhoven.,5Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Oscar Persson
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Elmi-Terander
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Schramm S, Mehta A, Auguste KI, Tarapore PE. Navigated transcranial magnetic stimulation mapping of the motor cortex for preoperative diagnostics in pediatric epilepsy. J Neurosurg Pediatr 2021; 28:287-294. [PMID: 34171834 DOI: 10.3171/2021.2.peds20901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) is a noninvasive technique often used for localization of the functional motor cortex via induction of motor evoked potentials (MEPs) in neurosurgical patients. There has, however, been no published record of its application in pediatric epilepsy surgery. In this study, the authors aimed to investigate the feasibility of nTMS-based motor mapping in the preoperative diagnostic workup within a population of children with medically refractory epilepsy. METHODS A single-institution database was screened for preoperative nTMS motor mappings obtained in pediatric patients (aged 0 to 18 years, 2012 to present) with medically refractory epilepsy. Patient clinical data, demographic information, and mapping results were extracted and used in statistical analyses. RESULTS Sixteen patients met the inclusion criteria, 15 of whom underwent resection. The median age was 9 years (range 0-17 years). No adverse effects were recorded during mapping. Specifically, no epileptic seizures were provoked via nTMS. Recordings of valid MEPs induced by nTMS were obtained in 10 patients. In the remaining patients, no MEPs could be elicited. Failure to generate MEPs was associated significantly with younger patient age (r = 0.8020, p = 0.0001863). The most frequent seizure control outcome was Engel Epilepsy Surgery Outcome Scale class I (9 patients). CONCLUSIONS Navigated TMS is a feasible, effective, and well-tolerated method for mapping the motor cortex of the upper and lower extremities in pediatric patients with epilepsy. Patient age modulates elicitability of MEPs, potentially reflecting various stages of myelination. Successful motor mapping has the potential to add to the existing presurgical diagnostic workup in this population, and further research is warranted.
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Affiliation(s)
- Severin Schramm
- 1Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Aashna Mehta
- 2Berkeley School of Public Health, University of California, Berkeley; and
| | - Kurtis I Auguste
- 3Department of Neurosurgery, University of California, San Francisco, California
| | - Phiroz E Tarapore
- 3Department of Neurosurgery, University of California, San Francisco, California
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Timoney N, Rutka JT. Recent Advances in Epilepsy Surgery and Achieving Best Outcomes Using High-Frequency Oscillations, Diffusion Tensor Imaging, Magnetoencephalography, Intraoperative Neuromonitoring, Focal Cortical Dysplasia, and Bottom of Sulcus Dysplasia. Neurosurgery 2017; 64:1-10. [DOI: 10.1093/neuros/nyx239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 07/27/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nessa Timoney
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA
- Department of Surgery, Division of Ne-urosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - James T. Rutka
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA
- Department of Surgery, Division of Ne-urosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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7
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Sonvenso DK, Itikawa EN, Santos MV, Santos LA, Trevisan AC, Bianchin MM, Pitella FA, Kato M, Carlotti CG, Busatto GF, Velasco TR, Santos AC, Leite JP, Sakamoto AC, Machado HR, Nunes AA, Wichert-Ana L. Systematic review of the efficacy in seizure control and safety of neuronavigation in epilepsy surgery: The need for well-designed prospective studies. Seizure 2015; 31:99-107. [DOI: 10.1016/j.seizure.2015.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 07/14/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022] Open
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Winston GP. Epilepsy surgery, vision, and driving: what has surgery taught us and could modern imaging reduce the risk of visual deficits? Epilepsia 2013; 54:1877-88. [PMID: 24199825 PMCID: PMC4030586 DOI: 10.1111/epi.12372] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2013] [Indexed: 11/29/2022]
Abstract
Up to 40% of patients with temporal lobe epilepsy (TLE) are refractory to medication. Surgery is an effective treatment but may cause new neurologic deficits including visual field deficits (VFDs). The ability to drive after surgery is a key goal, but a postoperative VFD precludes driving in 4-50% of patients even if seizure-free. VFDs are a consequence of damage to the most anterior portion of the optic radiation, Meyer's loop. Anatomic dissection reveals that the anterior extent of Meyer's loop is highly variable and may clothe the temporal horn, a key landmark entered during temporal lobe epilepsy surgery. Experience from surgery since the 1940s has shown that VFDs are common (48-100%) and that the degree of resection affects the frequency or severity of the deficit. The pseudowedge shape of the deficit has led to a revised retinotopic model of the organization of the optic radiation. Evidence suggests that the left optic radiation is more anterior and thus at greater risk. Alternative surgical approaches, such as selective amygdalo-hippocampectomy, may reduce this risk, but evidence is conflicting or lacking. The optic radiation can be delineated in vivo using diffusion tensor imaging tractography, which has been shown to be useful in predicting the postoperative VFDs and in surgical planning. These data are now being used for surgical guidance with the aim of reducing the severity of VFDs. Compensation for brain shift occurring during surgery can be performed using intraoperative magnetic resonance imaging (MRI), but the additional utility of this expensive technique remains unproven.
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Affiliation(s)
- Gavin P Winston
- Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom
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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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Meneses MSD, Kondageski C, Santos HNLD, Kowacs PA, Coelho GC, Gadens G, Rocha SBD, Simão C. The usefulness of neuronavigation in functional hemispherectomy. ACTA ACUST UNITED AC 2011. [DOI: 10.1590/s1676-26492011000300004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Catastrophic epileptic encephalopathies in children comprise devastating conditions that features cerebral dysfunction in association with refractory epileptic seizures. The diagnosis is based on the clinical findings, on magnetic resonance imaging (MRI) of the brain and on electroencephalographic findings. For these conditions, surgery remains essential for attaining seizure control. We report two cases of 5-year-old girls. The first one had a diagnosis of Rasmussen’s syndrome. The second one had a large porencephalic cyst secondary to perinatal cerebral ischemia. Despite trials of anticonvulsants, both patients deteriorated, and a functional hemispherectomy guided by neuronavigation was indicated and performed, with low morbidity and excellent seizure control. The neuronavigation proved to be a valuable guidance tool in performing the functional hemispherectomy, making the disconnections more accurate, and thus decreasing the surgical time and blood loss.
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