Freehand placement of depth electrodes using electromagnetic frameless stereotactic guidance

Technical note

View More View Less
  • 1 Departments of Neurology and
  • 4 Neurosurgery and
  • 7 Integrative Brain Imaging Center, University of Washington;
  • 2 Divisions of Pediatric Neurology,
  • 5 Pediatric Radiology, and
  • 6 Pediatric Neurosurgery, Seattle Children's Hospital;
  • 8 Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle; and
  • 3 Washington Neuroscience Institute, Renton, Washington
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

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.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Carter D. Wray, M.D., Seattle Children's Hospital, Division of Pediatric Neurology, MS B 5552, PO Box 5371, Seattle, Washington 98145. email: carterwraymd@gmail.com.
  • 1

    Azeem SS, & Origitano TC: Ventricular catheter placement with a frameless neuronavigational system: a 1-year experience. Neurosurgery 60:4 Suppl 2 243248, 2007

    • Search Google Scholar
    • Export Citation
  • 2

    Blatt DR, , Roper SN, & Friedman WA: Invasive monitoring of limbic epilepsy using stereotactic depth and subdural strip electrodes: surgical technique. Surg Neurol 48:7479, 1997

    • Search Google Scholar
    • Export Citation
  • 3

    Chamoun RB, , Nayar VV, & Yoshor D: Neuronavigation applied to epilepsy monitoring with subdural electrodes. Neurosurg Focus 25:3 E21, 2008

  • 4

    Davies KG, , Phillips BL, & Hermann BP: MRI confirmation of accuracy of freehand placement of mesial temporal lobe depth electrodes in the investigation of intractable epilepsy. Br J Neurosurg 10:175178, 1996

    • Search Google Scholar
    • Export Citation
  • 5

    Dorward NL, , Alberti O, , Dijkstra A, , Buurman J, , Kitchen ND, & Thomas DG: Clinical introduction of an adjustable rigid instrument holder for frameless stereotactic interventions. Comput Aided Surg 2:180185, 1997

    • Search Google Scholar
    • Export Citation
  • 6

    Kratimenos GP, , Thomas DG, , Shorvon SD, & Fish DR: Stereotactic insertion of intracerebral electrodes in the investigation of epilepsy. Br J Neurosurg 7:4552, 1993

    • Search Google Scholar
    • Export Citation
  • 7

    Mascott CR: In vivo accuracy of image guidance performed using optical tracking and optimized registration. J Neurosurg 105:561567, 2006

    • Search Google Scholar
    • Export Citation
  • 8

    McMillen JL, , Vonau M, & Wood MJ: Pinless frameless electromagnetic image-guided neuroendoscopy in children. Childs Nerv Syst 26:871878, 2010

    • Search Google Scholar
    • Export Citation
  • 9

    Mehta AD, , Labar D, , Dean A, , Harden C, , Hosain S, & Pak J, : Frameless stereotactic placement of depth electrodes in epilepsy surgery. J Neurosurg 102:10401045, 2005

    • Search Google Scholar
    • Export Citation
  • 10

    Muacevic A, , Uhl E, , Steiger HJ, & Reulen HJ: Accuracy and clinical applicability of a passive marker based frameless neuronavigation system. J Clin Neurosci 7:414418, 2000

    • Search Google Scholar
    • Export Citation
  • 11

    Murphy MA, , O'Brien TJ, & Cook MJ: Insertion of depth electrodes with or without subdural grids using frameless stereotactic guidance systems—technique and outcome. Br J Neurosurg 16:119125, 2002

    • Search Google Scholar
    • Export Citation
  • 12

    Ortler M, , Sohm F, , Eisner W, , Bauer R, , Dobesberger J, & Trinka E, : Frame-based vs frameless placement of intrahippocampal depth electrodes in patients with refractory epilepsy: a comparative in vivo (application) study. Neurosurgery 68:881887, 2011

    • Search Google Scholar
    • Export Citation
  • 13

    Reavey-Cantwell JF, , Bova FJ, & Pincus DW: Frameless, pinless stereotactic neurosurgery in children. J Neurosurg 104:6 Suppl 392395, 2006

    • Search Google Scholar
    • Export Citation
  • 14

    Rosenow JM, & Sootsman WK: Application accuracy of an electromagnetic field-based image-guided navigation system. Stereotact Funct Neurosurg 85:7581, 2007

    • Search Google Scholar
    • Export Citation
  • 15

    Ross DA, , Brunberg JA, , Drury I, & Henry TR: Intracerebral depth electrode monitoring in partial epilepsy: the morbidity and efficacy of placement using magnetic resonance imageguided stereotactic surgery. Neurosurgery 39:327334, 1996

    • Search Google Scholar
    • Export Citation
  • 16

    Shenai MB, , Ross DA, & Sagher O: The use of multiplanar trajectory planning in the stereotactic placement of depth electrodes. Neurosurgery 60:4 Suppl 2 272276, 2007

    • Search Google Scholar
    • Export Citation
  • 17

    Song JK, , Abou-Khalil B, & Konrad PE: Intraventricular monitoring for temporal lobe epilepsy: report on technique and initial results in eight patients. J Neurol Neurosurg Psychiatry 74:561565, 2003

    • Search Google Scholar
    • Export Citation
  • 18

    Spencer SS, , Spencer DD, , Williamson PD, & Mattson R: Combined depth and subdural electrode investigation in uncontrolled epilepsy. Neurology 40:7479, 1990

    • Search Google Scholar
    • Export Citation
  • 19

    Spire WJ, , Jobst BC, , Thadani VM, , Williamson PD, , Darcey TM, & Roberts DW: Robotic image-guided depth electrode implantation in the evaluation of medically intractable epilepsy. Neurosurg Focus 25:3 E19, 2008

    • Search Google Scholar
    • Export Citation
  • 20

    Stone SS, & Rutka JT: Utility of neuronavigation and neuromonitoring in epilepsy surgery. Neurosurg Focus 25:3 E17, 2008

  • 21

    Stuart RM, & Goodman RR: Novel use of a custom stereotactic frame for placement of depth electrodes for epilepsy monitoring. Neurosurg Focus 25:3 E20, 2008

    • Search Google Scholar
    • Export Citation
  • 22

    Talairach J, & Szikla G: Application of stereotactic concepts to the surgery of epilepsy. Acta Neurochir Suppl (Wien) 30:3554, 1980

  • 23

    Van Roost D, , Solymosi L, , Schramm J, , van Oosterwyck B, & Elger CE: Depth electrode implantation in the length axis of the hippocampus for the presurgical evaluation of medial temporal lobe epilepsy: a computed tomography-based stereotactic insertion technique and its accuracy. Neurosurgery 43:819827, 1998

    • Search Google Scholar
    • Export Citation
  • 24

    Yeh HS, , Taha JM, & Tobler WD: Implantation of intracerebral depth electrodes for monitoring seizures using the Pelorus stereotactic system guided by magnetic resonance imaging. Technical note. J Neurosurg 78:138141, 1993

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 448 202 8
Full Text Views 72 7 0
PDF Downloads 151 9 0
EPUB Downloads 0 0 0