The End Justifies the Means—A Call for Nuance in the Increasing Nationwide Adoption of Stereoelectroencephalography Over Subdural Electrode Monitoring in the Surgical Evaluation of Intractable Epilepsy

Oluigbo, Chima; Gaillard, William D.; Koubeissi, Mohamad Z.

doi:10.1001/jamaneurol.2021.4994

Cited by 3 publications

(4 citation statements)

References 10 publications

(12 reference statements)

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“…145,146 In recent years, there has been a dramatic surge in the utilization of depth electrodes due to the advances in neuroimaging, stereotactic robot, and minimally invasive surgical techniques. 147,148 Despite this emerging trend, many patients still benefit from intracranial EEG recording using subdural electrodes, particularly in specific circumstances such as seizure focus restricted in the neocortex or in proximity to eloquent cortex. In contrast, situations where subdural grids/strips can be misleading are bottom-of-the sulcus FCDs with a focal onset in the depth and rapid distant propagation or a burned-out ipsilateral hippocampus with rapid seizure propagation to the contralateral site (strips record not from the hippocampus directly, but the para-hippocampal gyrus and this structure may be activated on the contralateral side first in case of a severely atrophic ipsilateral structure).…”

Section: Special Considerations In Subdural Grids/stripsmentioning

confidence: 99%

“…A hybrid approach using both subdural and depth electrodes is often considered to leverage the strengths of both modalities and delineate seizure foci involving both subcortical and cortical networks 145,146 . In recent years, there has been a dramatic surge in the utilization of depth electrodes due to the advances in neuroimaging, stereotactic robot, and minimally invasive surgical techniques 147,148 . Despite this emerging trend, many patients still benefit from intracranial EEG recording using subdural electrodes, particularly in specific circumstances such as seizure focus restricted in the neocortex or in proximity to eloquent cortex.…”

Section: Special Considerations In Subdural Grids/stripsmentioning

confidence: 99%

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Learn how to interpret and use intracranial EEG findings

Frauscher,

Mansilla,

Abdallah

et al. 2024

Epileptic Disorders

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Epilepsy surgery is the therapy of choice for many patients with drug‐resistant focal epilepsy. Recognizing and describing ictal and interictal patterns with intracranial electroencephalography (EEG) recordings is important in order to most efficiently leverage advantages of this technique to accurately delineate the seizure‐onset zone before undergoing surgery. In this seminar in epileptology, we address learning objective “1.4.11 Recognize and describe ictal and interictal patterns with intracranial recordings” of the International League against Epilepsy curriculum for epileptologists. We will review principal considerations of the implantation planning, summarize the literature for the most relevant ictal and interictal EEG patterns within and beyond the Berger frequency spectrum, review invasive stimulation for seizure and functional mapping, discuss caveats in the interpretation of intracranial EEG findings, provide an overview on special considerations in children and in subdural grids/strips, as well as review available quantitative / signal analysis approaches. To be as practically oriented as possible, we will provide a mini atlas of the most frequent EEG patterns, highlight pearls for its not infrequently challenging interpretation, and conclude with two illustrative case examples. This article shall serve as a useful learning resource for trainees in clinical neurophysiology / epileptology by providing a basic understanding on the concepts of invasive intracranial EEG.

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Section: Special Considerations In Subdural Grids/stripsmentioning

confidence: 99%

Section: Special Considerations In Subdural Grids/stripsmentioning

confidence: 99%

Learn how to interpret and use intracranial EEG findings

Frauscher,

Mansilla,

Abdallah

et al. 2024

Epileptic Disorders

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“…Additional advantages of intracranial implantation are to perform brain mapping of functional areas and to elicit habitual seizures by using bipolar direct cortical stimulation (DCS). The utility of subdural electrodes is relevant when a putative SOZ resides on the cortical convexity and when mapping is necessary, as the grid matrix provides a better delineation of functional regions [34]. Frequently, depth and subdural electrodes are used in complementary fashion during challenging cases, locating the SOZ in up to 95% of cases when combined, with an overall haemorrhage risk of less than 5% [35 ▪ ].…”

Section: Recent Innovations In Surgical Techniquesmentioning

confidence: 99%

Recent advances in epilepsy surgery

Medina-Pizarro

Spencer²,

Damisah³

2023

Current Opinion in Neurology

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Purpose of reviewTechnological innovations in the preoperative evaluation, surgical techniques and outcome prediction in epilepsy surgery have grown exponentially over the last decade. This review highlights and emphasizes relevant updates in techniques and diagnostic tools, discussing their context within standard practice at comprehensive epilepsy centres. Recent findingsHigh-resolution structural imaging has set an unprecedented opportunity to detect previously unrecognized subtle abnormalities. Machine learning and computer science are impacting the methodologies to analyse presurgical and surgical outcome data, building more accurate prediction models to tailor treatment strategies. Robotic-assisted placement of depth electrodes has increased the safety and ability to sample epileptogenic nodes within deep structures, improving our understanding of the seizure networks in drugresistant epilepsy. The current available minimally invasive techniques are reasonable surgical alternatives to ablate or disrupt epileptogenic regions, although their sustained efficacy is still an active area of research.

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“…Over the past decade, SEEG has been gaining popularity worldwide due to advances in stereotactic techniques and neurosurgical robots and a shift from large resections to minimally invasive epilepsy surgery. 12 These two techniques possess distinct advantages and limitations, complementing each other in both their indications and applications. There is evidence showing the combination of SDEs and SEEG can be safely undertaken to mitigate the drawbacks of each technique.…”

Section: Introductionmentioning

confidence: 99%

Depth versus surface: A critical review of subdural and depth electrodes in intracranial electroencephalographic studies

Wu,

Issa,

Rose

et al. 2024

Epilepsia

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Intracranial electroencephalographic (IEEG) recording, using subdural electrodes (SDEs) and stereoelectroencephalography (SEEG), plays a pivotal role in localizing the epileptogenic zone (EZ). SDEs, employed for superficial cortical seizure foci localization, provide information on two‐dimensional seizure onset and propagation. In contrast, SEEG, with its three‐dimensional sampling, allows exploration of deep brain structures, sulcal folds, and bihemispheric networks. SEEG offers the advantages of fewer complications, better tolerability, and coverage of sulci. Although both modalities allow electrical stimulation, SDE mapping can tessellate cortical gyri, providing the opportunity for a tailored resection. With SEEG, both superficial gyri and deep sulci can be stimulated, and there is a lower risk of afterdischarges and stimulation‐induced seizures. Most systematic reviews and meta‐analyses have addressed the comparative effectiveness of SDEs and SEEG in localizing the EZ and achieving seizure freedom, although discrepancies persist in the literature. The combination of SDEs and SEEG could potentially overcome the limitations inherent to each technique individually, better delineating seizure foci. This review describes the strengths and limitations of SDE and SEEG recordings, highlighting their unique indications in seizure localization, as evidenced by recent publications. Addressing controversies in the perceived usefulness of the two techniques offers insights that can aid in selecting the most suitable IEEG in clinical practice.

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The End Justifies the Means—A Call for Nuance in the Increasing Nationwide Adoption of Stereoelectroencephalography Over Subdural Electrode Monitoring in the Surgical Evaluation of Intractable Epilepsy

Cited by 3 publications

References 10 publications

Learn how to interpret and use intracranial EEG findings

Learn how to interpret and use intracranial EEG findings

Recent advances in epilepsy surgery

Depth versus surface: A critical review of subdural and depth electrodes in intracranial electroencephalographic studies

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