Nowell Mark, Rodionov Roman, Diehl Beate, Wehner Tim, Zombori Gergely, Kinghorn Jane, Ourselin Sebastien, Duncan John, Miserocchi Anna, McEvoy Andrew
*Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom; ‡Epilepsy Society, MRI Unit, Chalfont St. Peter, United Kingdom; §Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom; ¶Centre of Medical Imaging and Computing, UCL, London, United Kingdom.
Neurosurgery. 2014 Dec;10 Suppl 4(4):525-33; discussion 533-4. doi: 10.1227/NEU.0000000000000544.
Stereoelectroencephalography (SEEG) is an invasive diagnostic procedure in epilepsy surgery that is usually implemented with frame-based methods.
To describe a new technique of frameless SEEG and report a prospective case series at a single center.
Image integration and planning of electrode trajectories were performed preoperatively on specialized software and exported to a Medtronic S7 StealthStation. Trajectories were implemented by frameless stereotaxy using percutaneous drilling and bolt insertion.
Twenty-two patients went this technique, with the insertion of 187 intracerebral electrodes. Of 187 electrodes, 175 accurately reached their neurophysiological target, as measured by postoperative computed tomography reconstruction and multimodal image integration with preoperative magnetic resonance imaging. Four electrodes failed to hit their target due to extradural deflection, and 3 were subsequently resited satisfactorily. Eight electrodes were off target by a mean of 3.6 mm (range, 0.9-6.8 mm) due to a combination of errors in bolt trajectory implementation and bending of the electrode. There was 1 postoperative hemorrhage that was clinically asymptomatic and no postoperative infections. Sixteen patients were offered definitive cortical resections, and 6 patients were excluded from resective surgery.
Frameless SEEG is a novel and safe method for implementing SEEG and is easily translated into clinical practice.
立体定向脑电图（SEEG）是癫痫手术中的一种侵入性诊断方法，通常采用基于框架的方法实施。
描述一种无框架SEEG新技术，并报告单中心的前瞻性病例系列。
术前在专用软件上进行图像整合和电极轨迹规划，并导出到美敦力S7 StealthStation。使用经皮钻孔和螺栓插入通过无框架立体定向技术实施轨迹。
22例患者采用该技术，共插入187根脑内电极。通过术后计算机断层扫描重建以及与术前磁共振成像的多模态图像整合测量，187根电极中有175根准确到达其神经生理学靶点。4根电极因硬膜外偏转而未能命中靶点，其中3根随后重新定位成功。由于螺栓轨迹实施错误和电极弯曲的综合作用，8根电极偏离靶点，平均偏离3.6 mm（范围0.9 - 6.8 mm）。术后有1例出血，临床无症状，无术后感染。16例患者接受了确定性皮质切除术，6例患者被排除在切除性手术之外。
无框架SEEG是一种实施SEEG的新颖且安全的方法，易于转化为临床实践。
