Stereoelectroencephalography: Surgical methodology, safety, and stereotactic application accuracy in 500 procedures

Francesco Cardinale, Massimo Cossu, Laura Castana, Giuseppe Casaceli, Marco Paolo Schiariti, Anna Miserocchi, Dalila Fuschillo, Alessio Moscato, Chiara Caborni, Gabriele Arnulfo, Giorgio Lo Russo

Research output: Contribution to journalArticlepeer-review


Background: Stereoelectroencephalography (SEEG) methodology, originally developed by Talairach and Bancaud, is progressively gaining popularity for the presurgical invasive evaluation of drug-resistant epilepsies. Objective: To describe recent SEEG methodological implementations carried out in our center, to evaluate safety, and to analyze in vivo application accuracy in a consecutive series of 500 procedures with a total of 6496 implanted electrodes. Methods: Four hundred nineteen procedures were performed with the traditional 2-step surgical workflow, which was modified for the subsequent 81 procedures. The new workflow entailed acquisition of brain 3-dimensional angiography and magnetic resonance imaging in frameless and markerless conditions, advanced multimodal planning, and robot-assisted implantation. Quantitative analysis for in vivo entry point and target point localization error was performed on a sub-data set of 118 procedures (1567 electrodes). Results: The methodology allowed successful implantation in all cases. Major complication rate was 12 of 500 (2.4%), including 1 death for indirect morbidity. Median entry point localization error was 1.43 mm (interquartile range, 0.91-2.21 mm) with the traditional workflow and 0.78 mm (interquartile range, 0.49-1.08 mm) with the new one (P <2.2 × 10). Median target point localization errors were 2.69 mm (interquartile range, 1.89-3.67 mm) and 1.77 mm (interquartile range, 1.25-2.51 mm; P <2.2 × 10), respectively. Conclusion: SEEG is a safe and accurate procedure for the invasive assessment of the epileptogenic zone. Traditional Talairach methodology, implemented by multimodal planning and robot-assisted surgery, allows direct electrical recording from superficial and deep-seated brain structures, providing essential information in the most complex cases of drug-resistant epilepsy. Abbreviations: DSA, digital subtraction angiographyEP, entry pointEPLE, entry point localization errorEZ, epileptogenic zoneSEEG, stereoelectroencephalographyTP, target pointTPLE, target point localization error.

Original languageEnglish
Pages (from-to)353-366
Number of pages14
Issue number3
Publication statusPublished - Mar 2013


  • Complications
  • Epilepsy surgery
  • In vivo application accuracy
  • Intraoperative imaging
  • Invasive EEG
  • Stereoelectroencephalography
  • Stereotaxy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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