Stereotactic EEG via multiple single-path omnidirectional trajectories within a single platform: institutional experience with a novel technique

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OBJECTIVE

Stereotactic electroencephalography (SEEG) is being used with increasing frequency to interrogate subcortical, cortical, and multifocal epileptic foci. The authors describe a novel technique for SEEG in patients with suspected epileptic foci refractory to medical management.

METHODS

In the authors’ technique, standard epilepsy evaluation and neuroimaging are used to create a hypothesis-driven SEEG plan, which informs the 3D printing of a novel single-path, multiple-trajectory, omnidirectional platform. Following skull-anchor platform fixation, electrodes are sequentially inserted according to the preoperative plan. The authors describe their surgical experience and technique based on a review of all cases, adult and pediatric, in which patients underwent invasive epilepsy monitoring via SEEG during an 18-month period at Vanderbilt University Medical Center. Platform and anatomical variables influencing localization error were evaluated using multivariate linear regression.

RESULTS

Using this novel technology, 137 electrodes were inserted in 15 patients with focal epilepsy with favorable recording results and no clinical complications. The mean entry point localization error was 1.42 mm (SD 0.98 mm), and the mean target point localization error was 3.36 mm (SD 2.68 mm). Platform distance, electrode trajectory angle, and intracranial distance, but not skull thickness, were independently associated with localization error.

CONCLUSIONS

The multiple-trajectory, single-path, omnidirectional platform offers satisfactory accuracy and favorable clinical results, while avoiding cumbersome frames and prohibitive up-front costs associated with other SEEG technologies.

ABBREVIATIONS DBS = deep brain stimulation; EPLE = entry point localization error; EZ = epileptogenic zone; IQR = interquartile range; MEG = magnetoencephalography; PET = positron emission tomography; SEEG = stereotactic electroencephalography; TPLE = target point localization error.

Article Information

Correspondence Michael C. Dewan, Department of Neurological Surgery, Vanderbilt University Medical Center, T-4224 Medical Center North, Nashville, TN 37232-2380. email: michael.dewan@vanderbilt.edu.

INCLUDE WHEN CITING Published online December 15, 2017; DOI: 10.3171/2017.6.JNS17881.

Disclosures Drs. Dawant, Pallavaram, and Konrad report holding equity in Neurotargeting, LLC, which produces the planning software used in this study under a licensing agreement with Vanderbilt University. Dr. Neimat reports a consultant relationship with FHC.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Three Starfix frames for a single patient requiring bilateral, multilobed interrogation. Right: A frame with 9 individual trajectories is affixed to the skull, and then electrodes are sequentially guided to their intracranial target. Figure is available in color online only.

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    The influence of platform distance on EPLE (squares) and TPLE (circles). The shaded area represents the 95% confidence interval. Figure is available in color online only.

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    The influence of insertion angle on EPLE (squares) and TPLE (circles). The shaded area represents the 95% confidence interval. Figure is available in color online only.

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    The influence of intracranial distance on TPLE (circles). The shaded area represents the 95% confidence interval. Figure is available in color online only.

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    The influence of platform distance and insertion angle on EPLE. The vertical legend on the right represents EPLE in millimeters. EPLE increases synergistically with distance and angle. Figure is available in color online only.

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