De Momi E, Caborni C, Cardinale F, Casaceli G, Castana L, Cossu M, Mai R, Gozzo F, Francione S, Tassi L, Lo Russo G, Antiga L, Ferrigno G
Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy.
"Claudio Munari" Centre for Epilepsy and Parkinson Surgery Ospedale Niguarda Ca' Granda, Milan, Italy.
Int J Comput Assist Radiol Surg. 2014 Nov;9(6):1087-97. doi: 10.1007/s11548-014-1004-1. Epub 2014 Apr 20.
StereoElectroEncephaloGraphy (SEEG) is done to identify the epileptogenic zone of the brain using several multi-lead electrodes whose positions in the brain are pre-operatively defined. Intracranial hemorrhages due to disruption of blood vessels can cause major complications of this procedure ([Formula: see text]1%). In order to increase the intervention safety, we developed and tested planning tools to assist neurosurgeons in choosing the best trajectory configuration.
An automated planning method was developed that maximizes the distance of the electrode from the vessels and avoids the sulci as entry points. The angle of the guiding screws is optimized to reduce positioning error. The planner was quantitatively and qualitatively compared with manually computed trajectories on 26 electrodes planned for three patients undergoing SEEG by four neurosurgeons. Quantitative comparison was performed computing for each trajectory using (a) the Euclidean distance from the closest vessel and (b) the incidence angle.
Quantitative evaluation shows that automatic planned trajectories are safer in terms of distance from the closest vessel with respect to manually planned trajectories. Qualitative evaluation performed by four neurosurgeons showed that the automatically computed trajectories would have been preferred to manually computed ones in 30% of the cases and were judged good or acceptable in about 86% of the cases. A significant reduction in time required for planning was observed with the automated system (approximately 1/10).
The automatic SEEG electrode planner satisfied the essential clinical requirements, by providing safe trajectories in an efficient timeframe.
立体定向脑电图（SEEG）通过使用多个在术前确定脑内位置的多导电极来识别脑内癫痫发作起始区。血管破裂导致的颅内出血可引发该手术的主要并发症（发生率约为1%）。为提高手术安全性，我们开发并测试了规划工具，以协助神经外科医生选择最佳的轨迹配置。
开发了一种自动规划方法，该方法可使电极与血管的距离最大化，并避免将脑沟作为进入点。优化导向螺钉的角度以减少定位误差。由四位神经外科医生对计划用于三名接受SEEG治疗患者的26个电极，将该规划器与手动计算的轨迹进行定量和定性比较。定量比较通过计算每个轨迹的（a）与最近血管的欧几里得距离和（b）入射角来进行。
定量评估表明，就与最近血管的距离而言，自动规划的轨迹比手动规划的轨迹更安全。四位神经外科医生进行的定性评估表明，在30%的情况下，自动计算的轨迹比手动计算的轨迹更可取，并且在约86%的情况下被判定为良好或可接受。使用自动系统观察到规划所需时间显著减少（约为原来的1/10）。
自动SEEG电极规划器通过在有效时间范围内提供安全的轨迹，满足了基本的临床要求。
