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Superior accuracy and precision of SEEG electrode insertion with frame-based vs. frameless stereotaxy methods

  • Technical Note - Functional Neurosurgery - Epilepsy
  • Published:
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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Funding

This work was supported by Medical Student Research Funding provided by the Morton Levitt Memorial Endowment Fund.

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Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Fady Girgis, Eric Ovruchesky, and Ignacio Saez. The first draft of the manuscript was written by Eric Ovruchesky, Fady Girgis, and Ignacio Saez, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fady Girgis.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This was a retrospective study that did not require patient consent, as determined by the university ethics board (UC Davis IRB#1440605).

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This article is part of the Topical Collection on Functional Neurosurgery - Epilepsy

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Girgis, F., Ovruchesky, E., Kennedy, J. et al. Superior accuracy and precision of SEEG electrode insertion with frame-based vs. frameless stereotaxy methods. Acta Neurochir 162, 2527–2532 (2020). https://doi.org/10.1007/s00701-020-04427-1

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  • DOI: https://doi.org/10.1007/s00701-020-04427-1

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