van der Loo Lars E, Schijns Olaf E M G, Hoogland Govert, Colon Albert J, Wagner G Louis, Dings Jim T A, Kubben Pieter L
Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands.
School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands.
Acta Neurochir (Wien). 2017 Sep;159(9):1733-1746. doi: 10.1007/s00701-017-3242-9. Epub 2017 Jul 5.
Stereoelectroencephalography (SEEG) is an established diagnostic technique for the localization of the epileptogenic zone in drug-resistant epilepsy. In vivo accuracy of SEEG electrode positioning is of paramount importance since higher accuracy may lead to more precise resective surgery, better seizure outcome and reduction of complications.
To describe experiences with the SEEG technique in our comprehensive epilepsy center, to illustrate surgical methodology, to evaluate in vivo application accuracy and to consider the diagnostic yield of SEEG implantations.
All patients who underwent SEEG implantations between September 2008 and April 2016 were analyzed. Planned electrode trajectories were compared with post-implantation trajectories after fusion of pre- and postoperative imaging. Quantitative analysis of deviation using Euclidean distance and directional errors was performed. Explanatory variables for electrode accuracy were analyzed using linear regression modeling. The surgical methodology, procedure-related complications and diagnostic yield were reported.
Seventy-six implantations were performed in 71 patients, and a total of 902 electrodes were implanted. Median entry and target point deviations were 1.54 mm and 2.93 mm. Several factors that predicted entry and target point accuracy were identified. The rate of major complications was 2.6%. SEEG led to surgical therapy of various modalities in 53 patients (69.7%).
This study demonstrated that entry and target point localization errors can be predicted by linear regression models, which can aid in identification of high-risk electrode trajectories and further enhancement of accuracy. SEEG is a reliable technique, as demonstrated by the high accuracy of conventional frame-based implantation methodology and the good diagnostic yield.
立体定向脑电图（SEEG）是一种用于定位药物难治性癫痫致痫区的成熟诊断技术。SEEG电极定位的体内准确性至关重要，因为更高的准确性可能导致更精确的切除手术、更好的癫痫发作结果并减少并发症。
描述我们综合癫痫中心使用SEEG技术的经验，说明手术方法，评估体内应用准确性，并考虑SEEG植入的诊断率。
分析2008年9月至2016年4月期间接受SEEG植入的所有患者。在术前和术后影像融合后，将计划的电极轨迹与植入后的轨迹进行比较。使用欧几里得距离和方向误差对偏差进行定量分析。使用线性回归模型分析电极准确性的解释变量。报告手术方法、与手术相关的并发症和诊断率。
71例患者进行了76次植入，共植入902根电极。进入点和靶点的中位偏差分别为1.54毫米和2.93毫米。确定了几个预测进入点和靶点准确性的因素。主要并发症发生率为2.6%。SEEG导致53例患者（69.7%）接受了各种方式的手术治疗。
本研究表明，进入点和靶点定位误差可以通过线性回归模型预测，这有助于识别高风险电极轨迹并进一步提高准确性。SEEG是一种可靠的技术，传统框架植入方法的高准确性和良好的诊断率证明了这一点。
