D'Agostino Erin, Kanter John, Song Yinchen, Aronson Joshua P
Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Oper Neurosurg (Hagerstown). 2020 Apr 1;18(4):409-416. doi: 10.1093/ons/opz200.
Implantation of depth electrodes to localize epileptogenic foci in patients with drug-resistant epilepsy can be accomplished using traditional rigid frame-based, custom frameless, and robotic stereotactic systems.
To evaluate the accuracy of electrode implantation using the FHC microTargeting platform, a custom frameless platform, without a rigid insertion cannula.
A total of 182 depth electrodes were implanted in 13 consecutive patients who underwent stereoelectroencephalography (SEEG) for drug-resistant epilepsy using the microTargeting platform and depth electrodes without a rigid guide cannula. MATLAB was utilized to evaluate targeting accuracy. Three manual coordinate measurements with high inter-rater reliability were averaged.
Patients were predominantly male (77%) with average age 35.62 (SD 11.0, range 21-57) and average age of epilepsy onset at 13.4 (SD 7.2, range 3-26). A mean of 14 electrodes were implanted (range 10-18). Mean operative time was 144 min (range 104-176). Implantation of 3 out of 182 electrodes resulted in nonoperative hemorrhage (2 small subdural hematomas and one small subarachnoid hemorrhage). Putative location of onset was identified in all patients. We demonstrated a median lateral target point localization error (LTPLE) of 3.95 mm (IQR 2.18-6.23), a lateral entry point localization error (LEPLE) of 1.98 mm (IQR 1.2-2.85), a target depth error of 1.71 mm (IQR 1.03-2.33), and total target point localization error (TPLE) of 4.95 mm (IQR 2.98-6.85).
Utilization of the FHC microTargeting platform without the use of insertion cannulae is safe, effective, and accurate. Localization of seizure foci was accomplished in all patients and accuracy of depth electrode placement was satisfactory.
对于耐药性癫痫患者，可使用基于传统刚性框架、定制无框架和机器人立体定向系统来植入深度电极以定位致痫灶。
评估使用FHC微靶向平台（一种定制无框架平台，无刚性插入套管）进行电极植入的准确性。
使用微靶向平台和无刚性引导套管的深度电极，对13例因耐药性癫痫接受立体脑电图（SEEG）检查的连续患者共植入182根深度电极。利用MATLAB评估靶向准确性。对具有高评分者间可靠性的三次手动坐标测量结果求平均值。
患者以男性为主（77%），平均年龄35.62岁（标准差11.0，范围21 - 57岁），癫痫发作平均起始年龄为13.4岁（标准差7.2，范围3 - 26岁）。平均植入14根电极（范围10 - 18根）。平均手术时间为144分钟（范围104 - 176分钟）。182根电极中有3根植入时出现非手术性出血（2例小的硬膜下血肿和1例小的蛛网膜下腔出血）。所有患者均确定了推测的发作起始位置。我们证明外侧靶点定位误差（LTPLE）中位数为3.95毫米（四分位间距2.18 - 6.23），外侧入点定位误差（LEPLE）为1.98毫米（四分位间距1.2 - 2.85），靶点深度误差为1.71毫米（四分位间距1.03 - 2.33），总靶点定位误差（TPLE）为4.95毫米（四分位间距2.98 - 6.85）。
使用无插入套管的FHC微靶向平台是安全、有效且准确的。所有患者均完成了癫痫灶的定位，深度电极放置的准确性令人满意。
