Frame-Based vs Frameless Placement of Intrahippocampal Depth Electrodes in Patients With Refractory Epilepsy: A Comparative in Vivo (Application) Study

Ortler, Martin; Sohm, Florian; Eisner, Wilhelm; Bauer, Richard; Dobesberger, Judith; Trinka, Eugen; Widmann, Gerlig; Bale, Reto

doi:10.1227/neu.0b013e3182098e31

Cited by 26 publications

(22 citation statements)

References 29 publications

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“…The accuracy in this study was better than those in earlier foreign reports, and similar to those in recent reports (2,16,18,21). Ortler et al compared the results of VBH frameless positioning systems (combined with neuronavigation) and Fischer-Leibinger frame systems for depth electrode implantation, and found that they had similar accuracies (16). In this study, the new generation neuronavigation approach exhibited more simplicity than Ortler's VBH frameless positioning system, due to no need for the installation of a positioning frame, the shorter time consumption, and a simpler operation.…”

Section: Electrode Implantationsupporting

confidence: 91%

“…With the development of neuronavigation technology, the accuracy could be constantly improved. The accuracy in this study was better than those in earlier foreign reports, and similar to those in recent reports (2,16,18,21). Ortler et al compared the results of VBH frameless positioning systems (combined with neuronavigation) and Fischer-Leibinger frame systems for depth electrode implantation, and found that they had similar accuracies (16).…”

Section: Electrode Implantationsupporting

confidence: 89%

“…The previous implantation of depth electrodes usually used the frame-based stereotactic method, and although it provided accurate implantation locations, the surgical procedures were much more complex. When time and tests are required, such as during a cerebral angiography, it would be difficult to implant multiple depth electrodes (9,16). Meanwhile, the puncturing process could injure blood vessels and important functional areas, thus increasing complications such as intracranial bleeding (2,9).…”

Section: █ Discussionmentioning

confidence: 99%

“…Meanwhile, the results showed that the accuracy difference of the 2 groups was only 0.24 mm. Because the accuracy requirement in epilepsy is lower than in other diseases, this low difference indicates that neuronavigation could meet the accuracy requirement for depth electrode implantation (11,16). Widmann et al (20) summarized the literature published between 1995-2010, and found that the overall accuracy of frame stereotactic system was slightly higher than the image navigation system.…”

Section: Electrode Implantationmentioning

confidence: 99%

“…Intracranial electrodes can be classified as epidural, subdural cortical (including strip-like and grid-like electrode), and depth electrodes, of which the depth electrode has been widely used in epilepsy surgery, and plays an important role in the epileptogenic focus evaluation of the medial temporal lobe (2,21). intracranial hemorrhage and other complications (3,16). In recent years, with the development of frameless image-navigation technology, the accuracy of positioning and puncturing has significantly improved, and has been applied in the implantation of epilepsy depth electrodes in some epilepsy centers, especially for SEEG, which requires the implantation of multiple depth electrodes (1,3,13).…”

Section: █ Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Comparison of neuronavigation and frame-based stereotactic system in implanting epileptic depth electrodes

Hou¹,

Chen²,

Shi³

et al. 2014

Turkish Neurosurgery

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Previously, depth electrode implantation was usually performed using the frame-based stereotactic method (14). The frame-based stereotactic system has high positioning precision, and is suitable for precise positioning and puncturing towards deep structures; for example in stereotactic biopsy or deep brain stimulation (DBS), which need accurate positioning (3, 6). The disadvantages of this method, however, are evident: 1) The puncturing process is complicated and time consuming, making it difficult to implant multiple electrodes (e.g. for stereoelectroencephalography [SEEG]) (16); 2) It is difficult to adjust the puncture direction and path in real-time, especially from a poor posture (16); 3) The puncturing process might injure blood vessels and other vital structures, causing █ INTRODUCTION Intracranial electrode tracing has become an important means for evaluating the epileptogenic focus, especially in patients whose epileptogenic loci cannot be located using electroencephalography and other non-invasive assessment tools. Invasive intracranial electroencephalography (iEEG) is the preferred means of determining the exact locations of epileptogenic foci (12, 21). Intracranial electrodes can be classified as epidural, subdural cortical (including strip-like and grid-like electrode), and depth electrodes, of which the depth electrode has been widely used in epilepsy surgery, and plays an important role in the epileptogenic focus evaluation of the medial temporal lobe (2, 21). AIM:To investigate the application of neuronavigation in the implantation of depth electrodes in patients with epilepsy. MATERIAL and METHODS:Thirty-six patients with epilepsy who were implanted with depth electrodes using neuronavigation were assessed for accuracy of implantation and associated complications. RESULTS:In the imaging navigation group, patients were implanted with 2-14 depth electrodes. The average number of implantations was 4.8 electrodes/case. The average implantation error was 2.03 ± 0.98 mm, exhibiting no significant difference compared to the frame-based stereotactic group. In the imaging group, an average of 19.4 min was required to implant each electrode, which was significantly shorter than the time required in the frame group (34.5 min). The temporal lobe was elucidated as the factor that affects electrode implantation accuracy. One patient in the imaging group exhibited a small amount of bleeding, and one suffered from cerebrospinal fluid leakage; however, the overall complication rate in the imaging group was lower than that in the frame group. CONCLUSION:Imaging navigation provides better means of depth electrode implantation; its implantation accuracy is similar to that of the frame-based stereotactic method and it is less time consuming and causes less complications, and is especially suitable for stereoelectroencephalography, which requires multiple depth electrodes.

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