Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Department of Radiology, Stanford University Medical Center, Stanford, California, USA.
Stereotact Funct Neurosurg. 2020;98(1):1-7. doi: 10.1159/000503693. Epub 2020 Feb 14.
Stereoelectroencephalography (SEEG) is a powerful intracranial diagnostic tool that requires accurate imaging for proper electrode trajectory planning to ensure efficacy and maximize patient safety. Computed tomography (CT) angiography and digital subtraction angiography are commonly used, but recent developments in magnetic resonance angiography allow for high-resolution vascular visualization without added risks of radiation. We report on the accuracy of electrode placement under robotic assistance planning utilizing a novel high-resolution magnetic resonance imaging (MRI)-based imaging modality.
Sixteen pediatric patients between February 2014 and October 2017 underwent SEEG exploration for epileptogenic zone localization. A gadolinium-enhanced 3D T1-weighted spoiled gradient recalled echo sequence with minimum echo time and repetition time was applied for background parenchymal suppression and vascular enhancement. Electrode placement accuracy was determined by analyzing postoperative CT scans laid over preoperative virtual electrode trajectory paths. Entry point, target point, and closest vessel intersection were measured.
For any intersection along the trajectory path, 57 intersected vessels were measured. The mean diameter of an intersected vessel was 1.0343 ± 0.1721 mm, and 21.05% of intersections involved superficial vessels. There were 157 overall intersection + near-miss events. The mean diameter for an involved vessel was 1.0236 ± 0.0928 mm, and superficial vessels were involved in 20.13%. Looking only at final electrode target, 3 intersection events were observed. The mean diameter of an intersected vessel was 1.0125 ± 0.2227 mm. For intersection + near-miss events, 24 were measured. An involved vessel's mean diameter was 1.1028 ± 0.2634 mm. For non-entry point intersections, 45 intersected vessels were measured. The mean diameter for intersected vessels was 0.9526 ± 0.0689 mm. For non-entry point intersections + near misses, 126 events were observed. The mean diameter for involved vessels was 0.9826 ± 0.1008 mm.
We believe this novel sequence allows better identification of superficial and deeper subcortical vessels compared to conventional T1-weighted gadolinium-enhanced MRI.
立体脑电图（SEEG）是一种强大的颅内诊断工具，需要准确的成像来进行适当的电极轨迹规划，以确保疗效并最大程度地提高患者安全性。计算机断层扫描（CT）血管造影和数字减影血管造影通常用于此，但磁共振血管造影的最新进展允许在不增加辐射风险的情况下进行高分辨率血管可视化。我们报告了在机器人辅助规划下利用新型高分辨率磁共振成像（MRI）成像方式进行电极放置的准确性。
2014 年 2 月至 2017 年 10 月期间，16 名儿科患者接受了 SEEG 探索以定位致痫灶。应用钆增强三维 T1 加权扰相梯度回波序列，采用最小回波时间和重复时间，以进行背景实质抑制和血管增强。通过分析术后 CT 扫描与术前虚拟电极轨迹路径的叠加来确定电极放置的准确性。测量了进入点、目标点和最近的血管交叉点。
在轨迹路径上的任何交点处，测量了 57 个交叉血管。交叉血管的平均直径为 1.0343 ± 0.1721 毫米，21.05%的交点涉及表浅血管。共有 157 个总体交点+近失事件。涉及血管的平均直径为 1.0236 ± 0.0928 毫米，20.13%涉及表浅血管。仅观察最终电极靶点，观察到 3 个交点事件。交叉血管的平均直径为 1.0125 ± 0.2227 毫米。对于交点+近失事件，测量了 24 个。涉及血管的平均直径为 1.1028 ± 0.2634 毫米。对于非进入点交点，测量了 45 个交叉血管。交叉血管的平均直径为 0.9526 ± 0.0689 毫米。对于非进入点交点+近失事件，观察到 126 个事件。涉及血管的平均直径为 0.9826 ± 0.1008 毫米。
我们认为与传统的钆增强 T1 加权 MRI 相比，这种新型序列可更好地识别表浅和深部皮质下血管。
