Standard work tools for dynamic stereoelectroencephalography using ROSA: naming convention and perioperative planning

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  • 1 Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana;
  • 2 Faculty of Medicine, Ain Shams University, Cairo, Egypt;
  • 3 Division of Pediatric Neurosurgery, Texas Children’s Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;
  • 4 Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children’s Hospital, Chicago; and
  • 5 Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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OBJECTIVE

The grid-based orthogonal placement of depth electrodes (DEs), initially defined by Jean Talairach and Jean Bancaud, is known as stereo-electroencephalography (sEEG). Although acceptance in the United States was initially slow, advances in imaging and technology have spawned a proliferation of North American epilepsy centers offering sEEG. Despite publications highlighting minimal access techniques and varied indications, standard work for phase I targeted DE has not been defined. In this article, the authors propose the term “dynamic sEEG” and define standard work tools and related common data elements to promote uniformity in the field.

METHODS

A multidisciplinary approach from July to August 2016 resulted in the production of 4 standard work tools for dynamic sEEG using ROSA: 1) a 34-page illustrated manual depicting a detailed workflow; 2) a planning form to collocate all the phase I data; 3) a naming convention for DEs that encodes the data defining it; and 4) a reusable portable perioperative planning and documentation board. A retrospective review of sEEG case efficiency was performed comparing those using standard work tools (between July 2016 and April 2017) with historical controls (between March 2015 and June 2016). The standard work tools were then instituted at another epilepsy surgery center, and the results were recorded.

RESULTS

The process for dynamic sEEG was formally reviewed, including anesthesia, positioning, perioperative nursing guidelines, surgical steps, and postoperative care for the workflow using cranial fixation and ROSA-guided placement. There was a 40% improvement in time per electrode, from 44.7 ± 9.0 minutes to 26.9 ± 6.5 minutes (p = 0.0007) following the development and use of the manual, the naming convention, and the reusable portable perioperative planning and documentation board. This standardized protocol was implemented at another institution and yielded a time per electrode of 22.3 ± 4.4 minutes.

CONCLUSIONS

The authors propose the term dynamic sEEG for stereotactic depth electrodes placed according to phase I workup data with the intention of converting to ablation. This workflow efficiency can be optimized using the standard work tools presented. The authors also propose a novel naming convention that encodes critical data and allows portability among providers. Use of a planning form for common data elements optimizes research, and global adoption could facilitate multicenter studies correlating phase I modality and seizure onset zone identification.

ABBREVIATIONS DE = depth electrode; DTI = diffusion tensor imaging; EEG = electroencephalography; iEEG = intracranial EEG; MEG = magnetoencephalography; MFG = middle frontal gyrus; OR = operating room; RHC = Riley Hospital for Children; SDG = subdural grid; sEEG = stereo-EEG; SOZ = seizure onset zone; TCH = Texas Children’s Hospital; T/DE = case time/number of DEs placed.

Supplementary Materials

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Contributor Notes

Correspondence Jeffrey S. Raskin: Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN. jraskin@iuhealth.org.

INCLUDE WHEN CITING Published online January 22, 2021; DOI: 10.3171/2020.8.PEDS20420.

Disclosures Dr. Curry: consultant for Medtronic.

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