Electrode placement for SEEG: Combining stereotactic technique with latest generation planning software for intraoperative visualization and postoperative evaluation of accuracy and accuracy predictors

Kogias, Evangelos; Altenmüller, Dirk‐Matthias; Karakolios, Kleanthis; Egger, Karl; Coenen, Volker A.; Schulze‐Bonhage, Andreas; Reinacher, Peter C.

doi:10.1016/j.clineuro.2022.107137

Cited by 6 publications

(8 citation statements)

References 16 publications

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“…This method allows the implantation of up to five electrodes, each of them could have from six to eight electrode contacts inside the insular cortex 2 . Robot‐assisted implantations are safe 56 and efficient, 57 whereas frameless oblique implantation bears the risk of inaccuracy at the target point in the insular cortex compared with other cerebral lobes 58 . An increased electrode length leads to increased inaccuracy due to lateral deviation at the target point 58 .…”

Section: Diagnostic Methods In Insular Epilepsymentioning

confidence: 99%

“…58 An increased electrode length leads to increased inaccuracy due to lateral deviation at the target point. 58 This inaccuracy can be corrected by a combination of frame-based stereotaxy with new generation planning software. 58 Oblique and orthogonal implantations can be combined during the same SEEG investigation to optimize the spatial sampling of the whole operculo-insular region.…”

Section: Stereo-electroencephalographymentioning

confidence: 99%

“…58 This inaccuracy can be corrected by a combination of frame-based stereotaxy with new generation planning software. 58 Oblique and orthogonal implantations can be combined during the same SEEG investigation to optimize the spatial sampling of the whole operculo-insular region. 2,15,51,59 Insular depth electrodes will be combined with the implantation of adjacent regions (frontal, parietal, or temporal) depending on the electro-clinical hypothesis about EZ.…”

Section: Stereo-electroencephalographymentioning

confidence: 99%

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Diagnostic and therapeutic approaches in refractory insular epilepsy

et al. 2023

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Due to heterogenous seizure semiology and poor contribution of scalp electroencephalography (EEG) signals, insular epilepsy requires use of the appropriate diagnostic tools for its diagnosis and characterization. The deep location of the insula also presents surgical challenges. The aim of this article is to review the current diagnostic and therapeutic tools and their contribution to the management of insular epilepsy. Magnetic resonance imaging (MRI), isotopic imaging, neurophysiological imaging, and genetic testing should be used and interpretated with caution. Isotopic imaging and scalp EEG have demonstrated a lower value in epilepsy from insular compared to temporal origin, which increases the interest of functional MRI and magnetoencephalography. Intracranial recording with stereoelectroencephalography (SEEG) is often required. The insular cortex, being highly connected and deeply located under highly functional areas, is difficult to reach, and its ablative surgery raises functional issues. Tailored resection based on SEEG or alternative curative treatments, such as radiofrequency thermocoagulation, laser interstitial thermal therapy, or stereotactic radiosurgery, have produced encouraging results. The management of insular epilepsy has benefited from major advances in the last years. Perspectives for diagnostic and therapeutic procedures will contribute to better management of this complex form of epilepsy.

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Section: Diagnostic Methods In Insular Epilepsymentioning

confidence: 99%

Section: Stereo-electroencephalographymentioning

confidence: 99%

Section: Stereo-electroencephalographymentioning

confidence: 99%

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Diagnostic and therapeutic approaches in refractory insular epilepsy

et al. 2023

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“…Aspiration biopsy using the Leksell stereotactic system (Elektra, Sweden) (LSS) is an established, minimally invasive neurosurgical procedure [ 1 ]. Developed by Lars Leksell in 1949 [ 2 ], the LSS has been used in many neurosurgical areas and stereotactical procedures, including placement of stereoelectroenecephalography electrodes [ 3 ] or tumor biopsies. Due to its high accuracy, LSS (Electra, Sweden) is preferred for surgical procedures in highly eloquent areas and suboccipitaly localized lesions, such as brainstem and cerebellar pathologies [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Patient Safety Comparison of Frameless and Frame-Based Stereotactic Navigation for Brain Biopsy—A Single Center Cohort Study

et al. 2022

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Leksell stereotactic system-based aspiration biopsy is a common procedure in the neurosurgical treatment of deep-seated or multiple brain lesions. This study aimed to evaluate the benefit of frameless biopsy using VarioGuide compared to frame-based biopsy using the Leksell stereotactic system (LSS). We analyzed all brain biopsies using VarioGuide or LSS at our neurooncological Department of Neurosurgery in the University Hospital of Bonn between January 2018 and August 2020. We analyzed demographic data, duration of surgery, size of lesion, localization, and early complications. Uni-variable analyses were carried out on data from both groups. In total, 109 biopsies were compared (40 VarioGuide vs. 69 LSS). Patients with VarioGuide were significant older (74 (62–80) years vs. 67 (57–76) years; p = 0.03) and had a shorter duration of general anesthesia (163 (138–194) min vs. 193 (167–215) min, p < 0.001). We found no significant differences in surgery duration (VarioGuide median 28 min (IQR 20–38); LSS: median 30 min (IQR 25–39); p = 0.1352) or in early complication rates (5% vs. 7%; p = 0.644). A slightly higher false negative biopsy rate was registered in the LSS group (3 vs. 1; p = 0.1347). The size of the lesions also did not differ significantly between the two groups (18.31 ± 26.35 cm3 vs. 12.63 ± 14.62; p = 0.15). Our data showed that biopsies performed using VarioGuide took significantly less time than LSS biopsies and did not differ in complication rates. Both systems offered a high degree of patient safety.

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“…SEEG suffers from a considerable undersampling of the insular cortex, particularly when performed with a lateral insertional approach, with the inherent risk of false localization of a presumed seizure onset zone based on the first contact displaying an ictal EEG pattern. SEEG furthermore carries an inherent risk of bleeding even in groups using latest technologies for electrode implantation [ 3 , 5 ], and particularly so in the insular region. Third, there is so far no evidence that SEEG performed in lesional cases contributes to an improved delineation of the epileptogenic area which is reflected in postsurgical outcome, and in our view, the individual decision to perform SEEG recordings has to balance inherent risks of this invasive approach with the additional information that can be expected in clear lesional cases.…”

mentioning

confidence: 99%