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Novel use of a custom stereotactic frame for placement of depth electrodes for epilepsy monitoring

Technical Note

R. Morgan Stuart and Robert R. Goodman

The authors describe the first reported application of a miniature, customized, one-time use, skull-mounted stereotactic frame for the implantation of depth electrodes for epilepsy monitoring.

Using a platform template, 4 skull fiducial markers were placed 1 week prior to surgery. A brain MR image and a CT scan were subsequently obtained. All planning (longitudinal trajectories into the hippocampi) was done preoperatively using personal computers in the office. No further workstation planning was necessary on the day of the operation. The StarFix microTargeting Platform system was secured to the previously implanted skull fiducial screws. Pin fixation was not required. The platform was used to identify the area of entry for the depth electrodes on the right and left sides. On each side, a 12-contact depth electrode was advanced to the depth of the targets without difficulty. A temporal craniotomy was then performed to place subdural electrodes.

The desired location of the electrodes was confirmed on postoperative imaging studies. There were no complications associated with the electrode implantation. The depth electrodes demonstrated symmetrical, robust coverage of each hippocampus, with epileptiform discharges observed bilaterally.

This first application of the StarFix platform for placing depth electrodes for epilepsy monitoring was both safe and feasible. With this technique, the patient does not need to be pinned or placed in a head holder, no imaging or computer planning is required on the day of implantation (which means there is no time pressure when the meticulous target/trajectory planning is done), and with bilateral posterior implants both bur holes can be made simultaneously. For these reasons this system may be preferable to existing methods of depth electrode implantation.

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Effect of antibiotic-impregnated shunt catheters in decreasing the incidence of shunt infection in the treatment of hydrocephalus

Daniel M. Sciubba, R. Morgan Stuart, Matthew J. McGirt, Graeme F. Woodworth, Amer Samdani, Benjamin Carson, and George I. Jallo

Object

The majority of shunt infections occur within 6 months of shunt placement and chiefly result from perioperative colonization of shunt components by skin flora. Antibiotic-impregnated shunt (AIS) systems have been designed to prevent such colonization. In this study, the authors evaluate the incidence of shunt infection after introduction of an AIS system in a population of children with hydrocephalus.

Methods

The authors retrospectively reviewed all pediatric patients who had undergone cerebrospinal fluid (CSF) shunt insertion at their institution over a 3-year period between April 2001 and March 2004. During the 18 months prior to October 2002, all CSF shunts included standard, nonimpregnated catheters. During the 18 months after October 2002, all CSF shunts included antibiotic-impregnated catheters. All patients were followed up for 6 months after shunt surgery, and all shunt-related complications, including shunt infection, were evaluated. The independent association of AIS catheter use with subsequent shunt infection was assessed via multivariate proportional hazards regression analysis.

A total of 211 pediatric patients underwent 353 shunt placement procedures. In the 18 months prior to October 2002, 208 (59%) shunts were placed with nonimpregnated catheters; 145 (41%) shunts were placed with AIS catheters in the 18 months after October 2002. Of patients with nonimpregnated catheters, 25 (12%) experienced shunt infection, whereas only two patients (1.4%) with antibiotic-impregnated catheters experienced shunt infection within the 6-month follow-up period (p < 0.01). Adjusting for intercohort differences via multivariate analysis, AIS catheters were independently associated with a 2.4-fold decreased likelihood of shunt infection.

Conclusions

The AIS catheter significantly reduced incidence of CSF shunt infection in children with hydrocephalus during the early postoperative period (< 6 months). The AIS system used is an effective instrument to prevent perioperative colonization of CSF shunt components.

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Abstracts of the 2017 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves Las Vegas, Nevada • March 8–11, 2017

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Oral Presentations 2015 AANS Annual Scientific Meeting Washington, DC • May 2–6, 2015

Published online August 1, 2015; DOI: 10.3171/2015.8.JNS.AANS2015abstracts