Department of Neurosurgery, University of California Davis School of Medicine, 4860 Y St. Suite 3740, Sacramento, 95817, USA.
Department of Neurology, University of California Davis School of Medicine, 4860 Y St. Suite 3740, Sacramento, 95817, USA.
Acta Neurochir (Wien). 2020 Oct;162(10):2527-2532. doi: 10.1007/s00701-020-04427-1. Epub 2020 May 26.
Stereotactic electroencephalography (SEEG) has largely become the preferred method for intracranial seizure localization in epileptic patients due to its low morbidity and minimally invasive approach. While robotic placement is gaining popularity, many centers continue to use manual frame-based and frameless methods for electrode insertion. However, it is unclear how these methods compare in regard to accuracy, precision, and safety. Here, we aim to compare frame-based insertion using a CRW frame (Integra®) and frameless insertion using the StealthStation™ S7 (Medtronic®) navigation system for common temporal SEEG targets.
We retrospectively examined electrode targets in SEEG patients that were implanted with either frame-based or frameless methods at a level 4 epilepsy center. We focused on two commonly used targets: amygdala and hippocampal head. Stealth station software was used to merge pre-operative MR with post-operative CT images for each patient, and coordinates for each electrode tip were calculated in relation to the midcommissural point. These were compared to predetermined ideal coordinates in regard to error and directional bias.
A total of 81 SEEG electrodes were identified in 23 patients (40 amygdala and 41 hippocampal head). Eight of 45 electrodes (18%) placed with the frameless technique and 0 of 36 electrodes (0%) placed with the frame-based technique missed their target and were not clinically useful. The average Euclidean distance comparing actual to ideal electrode tip coordinates for frameless vs. frame-based techniques was 11.0 mm vs. 7.1 mm (p < 0.001) for the amygdala and 12.4 mm vs. 8.5 mm (p < 0.001) for the hippocampal head, respectively. There were no hemorrhages or clinical complications in either group.
Based on this series, frame-based SEEG insertion is significantly more accurate and precise and results in more clinically useful electrode contacts, compared to frameless insertion using a navigation guidance system. This has important implications for centers not currently using robotic insertion.
立体定向脑电图 (SEEG) 由于其发病率低且微创，已成为癫痫患者颅内癫痫灶定位的首选方法。虽然机器人放置越来越受欢迎，但许多中心仍继续使用手动框架和无框架方法进行电极插入。然而，目前尚不清楚这些方法在准确性、精度和安全性方面的比较情况。在这里，我们旨在比较基于框架的插入方法，使用 CRW 框架 (Integra®) 和无框架插入方法，使用 StealthStation™ S7 (Medtronic®) 导航系统，用于常见的颞叶 SEEG 靶点。
我们回顾性地检查了在 4 级癫痫中心接受基于框架或无框架方法植入的 SEEG 患者的电极靶点。我们专注于两个常用的靶点：杏仁核和海马头。StealthStation 软件用于将每个患者的术前磁共振成像与术后 CT 图像合并，并计算每个电极尖端相对于中脑连合点的坐标。这些坐标与预定的理想坐标进行比较，以确定误差和方向偏差。
在 23 名患者中，共确定了 81 个 SEEG 电极（40 个杏仁核和 41 个海马头）。无框架技术放置的 45 个电极中有 8 个（18%）和基于框架技术放置的 36 个电极中没有 0 个（0%）电极接触到目标，因此没有临床用途。无框架与基于框架技术的实际电极尖端坐标与理想坐标之间的平均欧几里得距离分别为 11.0 毫米对 7.1 毫米（p<0.001）用于杏仁核和 12.4 毫米对 8.5 毫米（p<0.001）用于海马头。两组均无出血或临床并发症。
基于本系列研究，与使用导航引导系统的无框架插入相比，基于框架的 SEEG 插入明显更准确和精确，并且可以获得更多具有临床意义的电极接触。这对于目前不使用机器人插入的中心具有重要意义。
