Frameless stereotactic placement of depth electrodes in epilepsy surgery

Mehta, Ashesh D.; Labar, Douglas; Dean, Andrew; Harden, Cynthia L.; Hosain, Syed; Pak, Jayoung; Marks, David; Schwartz, Theodore H.

doi:10.3171/jns.2005.102.6.1040

Cited by 81 publications

(67 citation statements)

References 20 publications

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“…7,8,12,13,15 Freehand placement techniques have progressively been replaced with stereotactic and image-guided methods for improved accuracy and safety. Although the methods of frame-based stereotaxy are safe and well-established, in the setting of concurrent depth and grid placement requiring a craniotomy, the frame can obstruct the surgical field.…”

Section: Discussionmentioning

confidence: 99%

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Robotic image-guided depth electrode implantation in the evaluation of medically intractable epilepsy

Spire¹,

Jobst²,

Thadani³

et al. 2008

FOC

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Object The authors describe their experience with a technique for robotic implantation of depth electrodes in patients concurrently undergoing craniotomy and placement of subdural monitoring electrodes for the evaluation of intractable epilepsy. Methods Patients included in this study underwent evaluation in the Dartmouth Surgical Epilepsy Program and were recommended for invasive seizure monitoring with depth electrodes between 2006 and the present. In all cases an image-guided robotic system was used during craniotomy for concurrent subdural grid electrode placement. A total of 7 electrodes were placed in 4 patients within the time period. Results Three of 4 patients had successful localization of seizure onset, and 2 underwent subsequent resection. Of the patients who underwent resection, 1 is now seizure free, and the second has only auras. There was 1 complication after subpial grid placement but no complications related to the depth electrodes. Conclusions Robotic image-guided placement of depth electrodes with concurrent craniotomy is feasible, and the technique is safe, accurate, and efficient.

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Section: Discussionmentioning

confidence: 99%

“…When combined with craniotomy for placing of subdural grid electrodes, however, it can become cumbersome, inefficient, and limiting. 4,8 The use of frameless stereotaxy avoids these constraints and offers additional benefits. In this technical note we describe the use of a robotic frameless stereotactic system for the implantation of depth electrodes.…”

mentioning

confidence: 99%

Robotic image-guided depth electrode implantation in the evaluation of medically intractable epilepsy

Spire¹,

Jobst²,

Thadani³

et al. 2008

FOC

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“…35,36 Assim sendo, a aquisição de imagem pode ser feita em qualquer momento do período pré-operatório, sem a necessidade de adquiri-las no dia da cirurgia, com o halo, como no sistema convencional. Assim sendo o planejamento cirúrgico pode ser feito antes de o paciente ser trazido ao centro cirúrgico permitindo um início rápido do caso no dia da cirurgia.…”

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“…A morbidade referida pelos centros que utilizam EP varia de 1% a 5%, 3,35,36,[40][41][42][43][44] recaindo quase sempre sobre duas categorias: hemorragia ou infecção. Algumas medidas são importantes para prevenir estas duas principais complicações.…”

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Estereoeletroencefalografia na era da cirurgia guiada por imagem

Centeno

Yacubian

Caboclo

et al. 2009

J. epilepsy clin. neurophysiol.

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RESUMOIntrodução: A estereoeletroencefalografia (E-EEG), conforme introduzida na década de 50 por Talairach, é um método invasivo de análise tridimensional da zona epilpeptogênica, baseado na técnica de implantação intracraniana de eletrodos de profundidade (EP). O advento das modernas técnicas de cirurgia guiadas por imagem revolucionaram a técnica de implantação dos EP. Objetivo: O objetivo deste artigo é discutir os princípios da E-EEG e sua evolução, desde a era Talairach até a era atual, da cirurgia guiada por imagem, e suas perspectivas futuras. Conclusões: Embora os princípios gerais da E-EEG tenham permanecidos intactos ao longo dos anos, a implantação de EP, que é a técnica cirúrgica que viabiliza este método, sofreu uma tremenda evolução ao longo das últimas três décadas devido ao advento das modernas técnicas de imagem, de sistemas de computação e das novas técnicas estereotáxicas. O uso de sistemas robotizados, a evolução constante das técnicas de imagem e computação e a utilização de EP com sondas para micro diálise associados a si, abre no futuro uma enorme perspectiva para a aplicação dos EP e da E-EEG, tanto para uso investigativo como terapêutico. A descoberta de novos alvos, em localizações profundas e a fabricação de eletrodos "inteligentes", poderá incrementar, num futuro próximo, a necessidade do uso deste método.Unitermos: Epilepsia, estereoeletroencefalografia, eletrodo profundo, cirurgia guiada por imagem. ABSTRACT Stereoelectroencephalography in the era of imaging guide surgeryIntroduction: The stereoelectroencephalography (SEEG), introduced by Talairach in 50', is an invasive method of tridimensional analysis of epileptogenic zone based on the intracranial placement of depth electrodes (DE). The advent of modern imaging guided surgery had a tremendous impact in DE implantation techniques. Objective: The aim of this article is to discuss the main principles of SEEG and its evolution along the years since Talairach era until the imaging guide surgery era, with its new perspectives. Conclusions: Although the main principles of SEEG have remained intact, the placement of depth electrodes (DE) which is the surgical technique that supports this method has suffered a tremendous evolution along the last three decades due the advent of the modern imaging, the computer systems and the new stereotactic techniques. The use of robotic, the new imaging and computed systems and the use of probes of micro dialise adaptated to EP opened a tremendous perspective to DE and SEEG application as an investigative and therapeutical method. The discovery of new targets in deep brain localization and the manufacturing of "smart" DE, can increment, in a near future, the number of indications to this method.

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“…Its accuracy has been documented for applications in epilepsy surgery 15,21 as well as for other uses such as for biopsy sampling of brain lesions. 7,18 The advantages of neuronavigation have been described for various kinds of epilepsy surgery, from temporal lobectomy 17 to corpus callosotomy 11 to MEG-guided surgery.…”

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confidence: 99%

Neuronavigation applied to epilepsy monitoring with subdural electrodes

Chamoun¹,

Nayar²,

Yoshor³

2008

FOC

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Accurate localization of the epileptogenic zone is of paramount importance in epilepsy surgery. Despite the availability of noninvasive structural and functional neuroimaging techniques, invasive monitoring with subdural electrodes is still often indicated in the management of intractable epilepsy. Neuronavigation is widely used to enhance the accuracy of subdural grid placement. It allows accurate implantation of the subdural electrodes based on hypotheses formed as a result of the presurgical workup, and can serve as a helpful tool for resection of the epileptic focus at the time of grid explantation. The authors describe 2 additional simple and practical techniques that extend the usefulness of neuronavigation in patients with epilepsy undergoing monitoring with subdural electrodes. One technique involves using the neuronavigation workstation to merge preimplantation MR images with a postimplantation CT scan to create useful images for accurate localization of electrode locations after implantation. A second technique involves 4 holes drilled at the margins of the craniotomy at the time of grid implantation; these are used as fiducial markers to realign the navigation system to the original registration and allow navigation with the merged image sets at the time of reoperation for grid removal and resection of the epileptic focus. These techniques use widely available commercial navigation systems and do not require additional devices, software, or computer skills. The pitfalls and advantages of these techniques compared to alternatives are discussed.

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Frameless stereotactic placement of depth electrodes in epilepsy surgery

Cited by 81 publications

References 20 publications

Robotic image-guided depth electrode implantation in the evaluation of medically intractable epilepsy

Robotic image-guided depth electrode implantation in the evaluation of medically intractable epilepsy

Estereoeletroencefalografia na era da cirurgia guiada por imagem

Neuronavigation applied to epilepsy monitoring with subdural electrodes

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