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Carter D. Wray, Diana L. Kraemer, Tong Yang, Sandra L. Poliachik, Andrew L. Ko, Andrew Poliakov, Adam O. Hebb, Edward J. Novotny and Jeffrey G. Ojemann

E pilepsy surgery often includes the use of intracranial depth electrodes for the localization of epileptogenic zones that are deep within the brain and cannot be reached by subdural electrodes. Traditionally, depth electrodes have been placed with various framebased stereotactic methods. 2 , 6 , 7 , 9 , 10 , 16 , 18 , 22–24 More recently frameless systems have been used for the placement of depth electrodes. 3 , 7 , 9 , 11 , 12 , 15 , 19–21 This paper describes a new technique, using an electromagnetic frameless navigation system to place depth

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Jamie J. Van Gompel, Fredric B. Meyer, W. Richard Marsh, Kendall H. Lee and Gregory A. Worrell

patients with normal MR imaging and TLE originating from the dominant temporal lobe, a selected resection of neocortex or mesial temporal structures may yield better cognitive and memory outcomes. 14 Intracranial monitoring for temporal lobe seizure localization may require both neocortical subdural grids and hippocampal depth electrode implantation when the case is not clearly mesiotemporal. Subdural grid and strip electrodes are required to obtain adequate coverage of the lateral temporal neocortex for neocortical seizure localization and functional mapping of

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Ashesh D. Mehta, Douglas Labar, Andrew Dean, Cynthia Harden, Syed Hosain, Jayoung Pak, David Marks and Theodore H. Schwartz

include deep structures such as the hippocampus, amygdala, and subcortical heterotopias. 5, 20, 21, 24 Volume conduction of the electric fields generated by deep foci interferes with accurate localization based on recordings at the surface of the brain. 1, 26 Thus, accurate assessment of deep foci often requires placement of depth recording electrodes. 12, 22, 25 Depth electrodes were originally placed using the double-grid system in conjunction with angiography studies. 29 This technique, while accurate and safe, was time-consuming and imposed limitations on the

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Chandan G. Reddy, Nader S. Dahdaleh, Gregory Albert, Fangxiang Chen, Daniel Hansen, Kirill Nourski, Hiroto Kawasaki, Hiroyuki Oya and Matthew A. Howard III

A variety of intracranial electrode types and implantation strategies have been used to identify seizure foci in patients with medically refractory epilepsy. The specific device and implantation technique used are influenced by what brain region is targeted. Grid and strip electrodes are well suited for recording ECoG activity from surface cortical structures, but penetrating depth electrodes are required to access subcortical brain regions. Depth electrodes have been used for more than 50 years to target sites throughout the brain. Each site requires an

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Toshifumi Kamiryo and Edward R. Laws Jr.

I n cases of medically intractable seizures, depth electrode placement is an important procedure to define the focus of the seizure for possible surgical excision. 1, 3, 6 We previously used an orthogonal approach, 5, 9 but changed to an occipital burr hole approach to increase the accuracy of hippocampal recording and to lower the risk of complications. Computer software designed for three-dimensional neurosurgery planning, originally developed at the University of Virginia, has the ability to define a trajectory through the entire hippocampus. 2, 4, 7, 8

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William J. Spire, Barbara C. Jobst, Vijay M. Thadani, Peter D. Williamson, Terrance M. Darcey and David W. Roberts

subdural strip electrodes, subdural grid electrodes, and depth electrodes. 1 , 2 , 15 Although depth electrodes have been placed by freehand technique, the development of coregistration methodology and advanced neuroimaging has led to the wide adaptation of such stereotactic techniques today. 3 , 5 , 11 , 12 , 14 Placement of electrodes using a stereotactic frame is a common and expeditious procedure. When combined with craniotomy for placing of subdural grid electrodes, however, it can become cumbersome, inefficient, and limiting. 4 , 8 The use of frameless

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Richard D. Ashpole, Gavin C. A. Fabinyi and Milos Vosmansky

S tereotactic placement of flexible depth electrodes is widely used as a method of seizure characterization. Using a target-centered arc or other type of stereotactic frame, such as the Cosman-Roberts-Wells (CRW), the standard procedure consists of several stages. Initially, a hollow electrode introducer is directed toward the target. A wire electrode measuring the same length as the introducer is then inserted as far as the tip of the introducer, thus positioning the electrode at the exact target point. Then, as the introducer is withdrawn, the wire

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R. Morgan Stuart and Robert R. Goodman

I nvasive monitoring techniques for the localization of an epileptogenic foci in patients with partial epilepsy are well described. 1 Whereas subdural grid and strip recording electrodes provide a means of localizing foci on the cortical surface, the placement of depth electrodes is often necessary to investigate intraparenchymal brain structures such as the amygdala and hippocampus, and stereotactic guidance has proved useful in placing electrodes accurately within such structures. 1 , 2 , 5 The application of a miniature, customized, one-time use

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Michael R. Levitt, Jeffrey G. Ojemann and John Kuratani

I nsular epilepsy is a rare form of complex partial seizures. Seizure spread from the insula may mimic typical temporal lobe epilepsy on EEG or surface ECoG recordings. Depth electrodes can monitor insular cortex. We describe a case of seizures localized to the insular cortex only after depth electrode recording. A 2-year-old girl suffered from intractable partial complex seizures; video EEG tracings suggested mesial temporal foci. Intraoperative ECoG showed interictal activity in the frontoparietal operculum, and topectomies were performed. Her seizures

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Eisha A. Christian, Elysa Widjaja, Ayako Ochi, Hiroshi Otsubo, Stephanie Holowka, Elizabeth Donner, Shelly K. Weiss, Cristina Go, James Drake, O. Carter Snead and James T. Rutka

R esection of the epileptogenic lesion in patients with medically refractory epilepsy can result in a seizure-free outcome. Lesions such as focal cortical dysplasia (FCD) at the bottom of the sulcus (BOSD) are highly epileptogenic and are often small. These lesions are difficult to identify on MRI because of their small size and subtle imaging features. 2 , 5 Invasive intracranial monitoring with depth electrodes and subdural strips and grids is often used to confirm that the putative lesion is the primary zone of epileptogenesis, as well as to map the location