Division of Pediatric Neurosurgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY, USA.
Division of Pediatric Neurology, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY, USA.
Childs Nerv Syst. 2021 Jul;37(7):2251-2259. doi: 10.1007/s00381-021-05107-w. Epub 2021 Mar 18.
We describe a detailed evaluation of predictors associated with individual lead placement efficiency and accuracy for 261 stereoelectroencephalography (sEEG) electrodes placed for epilepsy monitoring in twenty-three children at our institution.
Intra- and post-operative data was used to generate a linear mixed model to investigate predictors associated with three outcomes (lead placement time, lead entry error, lead target error) while accounting for correlated observations from the same patients. Lead placement time was measured using electronic time-stamp records stored by the ROSA software for each individual electrode; entry and target site accuracy was measured using postoperative stereotactic CT images fused with preoperative electrode trajectory planning images on the ROSA computer software. Predictors were selected from a list of variables that included patient demographics, laterality of leads, anatomic location of lead, skull thickness, bolt cap device used, and lead sequence number.
Twenty-three patients (11 female, 48%) of mean age 11.7 (± 6.1) years underwent placement of intracranial sEEG electrodes (median 11 electrodes) at our institution over a period of 1 year. There were no associated infections, hemorrhages, or other adverse events, and successful seizure capture was obtained in all monitored patients. The mean placement time for individual electrodes across all patients was 6.56 (± 3.5) min; mean target accuracy was 4.5 (± 3.5) mm. Lesional electrodes were associated with 25.7% (95% CI: 6.7-40.9%, p = 0.02) smaller target point errors. Larger skull thickness was associated with larger error: for every 1-mm increase in skull thickness, there was a 4.3% (95% CI: 1.2-7.5%, p = 0.007) increase in target error. Bilateral lead placement was associated with 26.0% (95% CI: 9.9-44.5%, p = 0.002) longer lead placement time. The relationship between placement time and lead sequence number was nonlinear: it decreased consistently for the first 4 electrodes, and became less pronounced thereafter.
Variation in sEEG electrode placement efficiency and accuracy can be explained by phenomena both within and outside of operator control. It is important to keep in mind the factors that can lead to better or worse lead placement efficiency and/or accuracy in order to maximize patient safety while maintaining the standard of care.
我们描述了一项详细的评估，评估了与 23 名在我院接受癫痫监测的患者的 261 个立体脑电图 (sEEG) 电极的个体导联放置效率和准确性相关的预测因子。
利用术中及术后数据，生成线性混合模型，探讨与三个结果（导联放置时间、导联入口误差、导联目标误差）相关的预测因子，同时考虑来自同一患者的相关观测值。通过 ROSA 软件为每个电极存储的电子时间戳记录来测量导联放置时间；使用术后立体 CT 图像与 ROSA 计算机软件上的术前电极轨迹规划图像融合来测量入口和目标部位的准确性。预测因子是从一组变量中选择的，包括患者人口统计学特征、导联的侧别、导联的解剖位置、颅骨厚度、使用的螺栓帽装置以及导联序号。
23 名患者（11 名女性，48%）接受了颅内 sEEG 电极的放置（平均 11 个电极），在我院进行了为期 1 年的治疗。没有发生感染、出血或其他不良事件，所有监测患者均成功捕获癫痫发作。所有患者的单个电极的平均放置时间为 6.56（±3.5）min；平均目标精度为 4.5（±3.5）mm。病灶性电极与较小的目标点误差（95%CI：6.7-40.9%，p=0.02）相关。颅骨厚度越大，误差越大：颅骨厚度每增加 1mm，目标误差增加 4.3%（95%CI：1.2-7.5%，p=0.007）。双侧导联放置与导联放置时间延长（95%CI：9.9-44.5%，p=0.002）相关。放置时间与导联序号之间的关系是非线性的：前 4 个导联的放置时间持续下降，此后下降趋势不明显。
sEEG 电极放置效率和准确性的变化可以用操作者控制范围内和范围外的现象来解释。为了在保持护理标准的同时最大限度地提高患者安全性，了解可能导致导联放置效率和/或准确性更好或更差的因素非常重要。
