Clinical Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria.
Neurosurgery. 2011 Apr;68(4):881-7; discussion 887. doi: 10.1227/NEU.0b013e3182098e31.
Despite progress in imaging technologies, documentation of unifocal electrical excitability is pivotal in patient selection for epilepsy surgery.
To compare the application accuracy of the Vogele-Bale-Hohner system (VBH), a maxillary fixation system with an external fiducial frame permitting frameless stereotactic guidance, with that of conventional frame-based stereotaxy for placement of intrahippocampal depth electrodes (DEs) in patients with refractory epilepsy.
Retrospective study. Comparison of two patient cohorts with DEs implanted along the occipitotemporal axis (group A, VBH; group B, frame-based stereotaxy). In vivo accuracy (lateral target localization error [TLE]), determined postoperatively by measuring the normal distance between virtual target and real electrode position at the tip and at 4cm from the tip, number of electrode contacts within the target structure, and diagnostic quality of electroencephalogram recordings were compared.
Seventeen DEs (A, 6 electrodes, 60 contacts; B, 11 electrodes, 90 contacts) were placed. electroencephalogram recordings via DEs supported further treatment decisions in all patients. TLE was 2.433 ± 0.977 mm (SD) (95% confidence interval [CI], 1.715-3.214 mm) (A) and 1.803 ± 0.392 mm (SD) (95% CI,1.511-2.195 mm) (B) (P = .185). Maximal error was 4 mm (A) and 3.2 mm (B). TLE 4 cm from the tip was 2.166 ± 2.188 mm (SD) (95% CI,0.438-3.916 mm) (A) and 1.372 ± 0.548 mm (SD) (95% CI,1.049-1.695 mm) (B) (P = .39). Maximal error 4 cm from the tip was 6.4 mm (A) and 2.14 mm (B). On average, 7 (A) and 5 (B) electrode contacts were placed in the target region.
The VBH and frame-based systems offer similar in vivo accuracy for intrahippocampal DE placement. With frame-based methods, accuracy is higher but the number of contacts per side is lower. This does not translate to clinically important differences.
尽管影像学技术取得了进展，但记录单灶性电兴奋性在癫痫手术患者选择中至关重要。
比较 Vogele-Bale-Hohner 系统（VBH）与传统框架立体定向技术在放置难治性癫痫患者海马内深部电极（DE）时的应用准确性，VBH 是一种带有外部基准框架的上颌固定系统，允许无框架立体定向引导。
回顾性研究。比较两组沿枕颞轴植入 DE 的患者（A 组，VBH；B 组，基于框架的立体定向）。术后通过测量虚拟目标与实际电极尖端和尖端 4cm 处的正常距离、目标结构内电极接触的数量以及脑电图记录的诊断质量来比较术中准确性（横向目标定位误差[TLE]）。
共放置 17 个 DE（A 组 6 个电极，60 个接触点；B 组 11 个电极，90 个接触点）。所有患者均通过 DE 进行脑电图记录，以支持进一步的治疗决策。TLE 为 2.433±0.977mm（SD）（95%置信区间[CI]，1.715-3.214mm）（A）和 1.803±0.392mm（SD）（95%CI，1.511-2.195mm）（B）（P=0.185）。最大误差为 4mm（A）和 3.2mm（B）。尖端 4cm 处的 TLE 为 2.166±2.188mm（SD）（95%CI，0.438-3.916mm）（A）和 1.372±0.548mm（SD）（95%CI，1.049-1.695mm）（B）（P=0.39）。尖端 4cm 处的最大误差为 6.4mm（A）和 2.14mm（B）。平均而言，A 组有 7 个电极和 B 组有 5 个电极接触放置在目标区域。
VBH 和基于框架的系统在海马内 DE 放置方面提供了相似的术中准确性。使用基于框架的方法，准确性更高，但每侧的电极接触数较低。这并没有转化为临床上的显著差异。
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