TY - JOUR
T1 - Stereoelectroencephalography
T2 - Surgical methodology, safety, and stereotactic application accuracy in 500 procedures
AU - Cardinale, Francesco
AU - Cossu, Massimo
AU - Castana, Laura
AU - Casaceli, Giuseppe
AU - Schiariti, Marco Paolo
AU - Miserocchi, Anna
AU - Fuschillo, Dalila
AU - Moscato, Alessio
AU - Caborni, Chiara
AU - Arnulfo, Gabriele
AU - Lo Russo, Giorgio
PY - 2013/3
Y1 - 2013/3
N2 - 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.
AB - 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.
KW - Complications
KW - Epilepsy surgery
KW - In vivo application accuracy
KW - Intraoperative imaging
KW - Invasive EEG
KW - Stereoelectroencephalography
KW - Stereotaxy
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UR - http://www.scopus.com/inward/citedby.url?scp=84874393282&partnerID=8YFLogxK
U2 - 10.1227/NEU.0b013e31827d1161
DO - 10.1227/NEU.0b013e31827d1161
M3 - Article
C2 - 23168681
AN - SCOPUS:84874393282
VL - 72
SP - 353
EP - 366
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 3
ER -