Approach Angle Affects Accuracy in Robotic Stereoelectroencephalography Lead Placement

Iordanou, Jordan C.; Câmara, Divaldo; Ghatan, Saadi; Panov, Fedor

doi:10.1016/j.wneu.2019.04.143

Cited by 36 publications

(31 citation statements)

References 18 publications

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“…Inaccuracies at the entry point and distance to the target logically have a negative impact on target accuracy. An angle > 30° between the skull and the trajectory can lead to significant target deviations ( 45 ). Globally, target errors are in a range from 1.0 to 3.0 mm with 0.5 to 1.5 mm of difference between oblique and orthogonal trajectories.…”

Section: Indications For Insular Seegmentioning

confidence: 99%

Indications, Techniques, and Outcomes of Robot-Assisted Insular Stereo-Electro-Encephalography: A Review

et al. 2020

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Stereo-electro-encephalography (SEEG) is an invasive, surgical, and electrophysiological method for three-dimensional registration and mapping of seizure activity in drug-resistant epilepsy. It allows the accurate analysis of spatio-temporal seizure activity by multiple intraparenchymal depth electrodes. The technique requires rigorous non-invasive pre-SEEG evaluation (clinical, video-EEG, and neuroimaging investigations) in order to plan the insertion of the SEEG electrodes with minimal risk and maximal recording accuracy. The resulting recordings are used to precisely define the surgical limits of resection of the epileptogenic zone in relation to adjacent eloquent structures. Since the initial description of the technique by Talairach and Bancaud in the 1950's, several techniques of electrode insertion have been used with accuracy and relatively few complications. In the last decade, robot-assisted surgery has emerged as a safe, accurate, and time-saving electrode insertion technique due to its unparalleled potential for orthogonal and oblique insertion trajectories, guided by rigorous computer-assisted planning. SEEG exploration of the insular cortex remains difficult due to its anatomical location, hidden by the temporal and frontoparietal opercula. Furthermore, the close vicinity of Sylvian vessels makes surgical electrode insertion challenging. Some epilepsy surgery teams remain cautious about insular exploration due to the potential of neurovascular injury. However, several authors have published encouraging results regarding the technique's accuracy and safety in both children and adults. We will review the indications, techniques, and outcomes of insular SEEG exploration with emphasis on robot-assisted implantation.

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Section: Indications For Insular Seegmentioning

confidence: 99%

Indications, Techniques, and Outcomes of Robot-Assisted Insular Stereo-Electro-Encephalography: A Review

et al. 2020

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“…Nevertheless, compared with conventionally-implanted electrodes, accurately implanting SEEG electrodes is challenging, especially for high skew-angle trajectories (more than 30 degrees). This can lead to a larger error in the accuracy because an oblique trajectory often leads to the drill sliding at the entrance of the skull and a subsequent error in the direction of the electrode (9). Accuracy is the key to depth electrode implantation.…”

Section: Discussionmentioning

confidence: 99%

How can the accuracy of SEEG be increased?—an analysis of the accuracy of multilobe-spanning SEEG electrodes based on a frameless stereotactic robot-assisted system

Lü¹,

Chen²,

An³

et al. 2021

Ann Palliat Med

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Background: A frameless stereotactic robot-assisted system allows stereoelectroencephalography (SEEG) electrodes to span multiple lobes. As the angularity and length are increased, maintaining accuracy of the electrodes becomes more challenging. The goal of this study was to analyze the factors that influence the accuracy of multilobe-spanning SEEG electrodes inserted using a frameless stereotactic robot-assisted system.Methods: A total of 322 SEEG electrodes were implanted in 39 patients with refractory epilepsy, and sixtyone multilobe-spanning SEEG electrodes were selected to analyze the factors that influenced the accuracy of implantation. The target error, entrance error, depth error, and angular error were calculated by a specialized computer program. Factors including electrode depth, angular deviation, referencing method, head holder choice, and use of a predrill procedure were analyzed to determine their effects on accuracy.Results: Thirty-nine patients (aged 2-35 years, median: 19 years; 21 females) underwent frameless robotassisted SEEG electrode implantation. The mean distance between the intended target and actual tip location was 2.57±1.70 mm (range, 0.42-9.02 mm). The mean distance between the intended entrance point and the actual location was 2.2±1.29 mm (range, 0.70-6.13 mm). The mean length of the electrodes was 84.63±7.61 mm (range, 70.60-103.99 mm). The depth error was 1.36±1.22 mm (range, 0.03-6.69 mm), and the angular deviation was 1.64±1.12 degrees (range, 0.15-4.93 degrees). Multifactor regression analysis showed that entrance error, electrode depth, depth error, angular deviation, referencing method, and head holder choice could explain 59.5% of the electrode target error. Angular deviation, choice of registration approach and head holder and the use of a predrill procedure could explain 48.1% of the electrode entrance error. Use of a predrill procedure significantly reduced the electrode angular deviation (P<0.05).Conclusions: Head holder choice, use of a predrill procedure and angular deviation are the primary influencing factors of the accuracy of multilobe-spanning SEEG electrode placement. The Leksell frame and a predrill procedure can be used to increase the accuracy of SEEG electrode placement.

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“…To avoid skiving of the drill bit, the entry angles are kept preferably within 30° from the axis perpendicular to the skull surface. 31) To reduce the risk of hemorrhagic complications, we avoid sulci and areas with a large subdural space (due to atrophy or previous surgical cavity) as the entry point; and keep a distance of at least 5 mm especially from the superficial cortical vessels visible on gadolinium enhanced T1-weighted MRI, given that most SEEGrelated bleeds are superficial 27,28) likely because the superficial vessels are less mobile and thus prone to injury. To minimize deviation, the trajectories are kept short.…”

Section: Fig 1 Techniques Of Seeg Electrode Placement and The Instrumentioning

confidence: 99%

“…To minimize deviation, the trajectories are kept short. 31) Electrodes entering through the occipital convexity create pressure point when a patient is lying supine and thus are avoided. Entry anterior to hair line in the frontal region is avoided for cosmetic reason.…”

Section: Fig 1 Techniques Of Seeg Electrode Placement and The Instrumentioning

confidence: 99%

Technical Aspects of SEEG and Its Interpretation in the Delineation of the Epileptogenic Zone

Khoo

Hall

Dubeau

et al. 2020

Neurol. Med. Chir.(Tokyo)

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Stereo-electroencephalography (SEEG) has gained global popularity in recent years. In Japan, a country in which invasive studies using subdural electrodes (SDEs) have been the mainstream, SEEG has been approved for insurance coverage in 2020 and is expected to gain in popularity. Some concepts supporting SEEG methodology are fundamentally different from that of SDE studies. Clinicians interested in utilizing SEEG in their practice should be aware of those aspects in which they differ. Success in utilizing the SEEG methodology relies heavily on the construction of an a priori hypothesis regarding the putative seizure onset zone (SOZ) and propagation. This article covers the technical and theoretical aspects of SEEG, including the surgical techniques and precautions, hypothesis construction, and the interpretation of the recording, all with the aim of providing an introductory guide to SEEG.

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Approach Angle Affects Accuracy in Robotic Stereoelectroencephalography Lead Placement

Cited by 36 publications

References 18 publications

Indications, Techniques, and Outcomes of Robot-Assisted Insular Stereo-Electro-Encephalography: A Review

Indications, Techniques, and Outcomes of Robot-Assisted Insular Stereo-Electro-Encephalography: A Review

How can the accuracy of SEEG be increased?—an analysis of the accuracy of multilobe-spanning SEEG electrodes based on a frameless stereotactic robot-assisted system

Technical Aspects of SEEG and Its Interpretation in the Delineation of the Epileptogenic Zone

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