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.
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.
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.
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.
ABBREVIATIONSDBS = 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.
Correspondence Michael C. Dewan, Department of Neurological Surgery, Vanderbilt University Medical Center, T-4224 Medical Center North, Nashville, TN 37232-2380. email: firstname.lastname@example.org.
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.
BalanescuBFranklinRCiureaJMindrutaIRasinaABobulescuRC: A personalized stereotactic fixture for implantation of depth electrodes in stereoelectroencephalography. Stereotact Funct Neurosurg92:117–1252014
D’HaesePFPallavaramSKonradPENeimatJFitzpatrickJMDawantBM: Clinical accuracy of a customized stereotactic platform for deep brain stimulation after accounting for brain shift. Stereotact Funct Neurosurg88:81–872010
Gonzalez-MartinezJBulacioJAlexopoulosAJehiLBingamanWNajmI: Stereoelectroencephalography in the “difficult to localize” refractory focal epilepsy: early experience from a North American epilepsy center. Epilepsia54:323–3302013
KonradPENeimatJSYuHKaoCCRempleMSD’HaesePF: Customized, miniature rapid-prototype stereotactic frames for use in deep brain stimulator surgery: initial clinical methodology and experience from 263 patients from 2002 to 2008. Stereotact Funct Neurosurg89:34–412011
PallavaramSDʼHaesePFLakeWKonradPEDawantBMNeimatJS: Fully automated targeting using nonrigid image registration matches accuracy and exceeds precision of best manual approaches to subthalamic deep brain stimulation targeting in Parkinson disease. Neurosurgery76:756–7652015
RoesslerKSommerBMerkelARamppSGollwitzerSHamerHM: A frameless stereotactic implantation technique for depth electrodes in refractory epilepsy using intraoperative magnetic resonance imaging. World Neurosurg94:206–2102016