Stereoelectroencephalography: Surgical Methodology, Safety, and Stereotactic Application Accuracy in 500 Procedures
Stereoelectroencephalography: Surgical Methodology, Safety, and Stereotactic Application Accuracy in 500 Procedures
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DOI：
10.1227/neu.0b013e31827d1161
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发表时间：
2013-03-01
期刊：
影响因子：
4.8
通讯作者：
Lo Russo, Giorgio
中科院分区：
文献类型：
--
作者：
Cardinale, Francesco;Cossu, Massimo;Lo Russo, Giorgio
背景技术：立体脑电描记术（SEEG）方法，最初由Talairach和Bancaud开发，是逐渐获得普及的术前侵入性评估的抗药性epilepsies.Objective：描述最近SEEG方法的实施进行了在我们的中心，以评估安全性，并分析在体内应用的准确性，在一个连续系列的500个程序，共6496植入电极。419例手术采用传统的2步手术工作流程进行，随后对81例手术进行了修改。新的工作流程需要在无框架和无标记条件下采集脑三维血管造影和磁共振成像，先进的多模式规划和机器人辅助植入。对118例手术（1567个电极）的子数据集进行了体内进入点和靶点定位误差的定量分析。严重并发症发生率为12/500（2.4%），包括1例间接发病死亡。传统工作流程的中位进针点定位误差为1.43 mm（四分位距，0.91-2.21 mm），而新工作流程的中位进针点定位误差为0.78 mm（四分位距，0.49-1.08 mm）（P < 2.2 X 10（-16））。中位靶点定位误差分别为2.69 mm（四分位距，1.89-3.67 mm）和1.77 mm（四分位距，1.25-2.51 mm; P < 2.2 × 10（-16））。通过多模式规划和机器人辅助手术实施的传统Talairach方法，允许从浅表和深层大脑结构直接进行电记录，为最复杂的耐药性癫痫病例提供重要信息。
BACKGROUND: Stereoelectroencephalography (SEEG) methodology, originally developed by Talairach and Bancaud, is progressively gaining popularity for the presurgical invasive evaluation of drug-resistant epilepsies.OBJECTIVE: To describe recent SEEG methodological implementations carried out in our center, to evaluate safety, and to analyze in vivo application accuracy in a consecutive series of 500 procedures with a total of 6496 implanted electrodes.METHODS: Four hundred nineteen procedures were performed with the traditional 2-step surgical workflow, which was modified for the subsequent 81 procedures. The new workflow entailed acquisition of brain 3-dimensional angiography and magnetic resonance imaging in frameless and markerless conditions, advanced multimodal planning, and robot-assisted implantation. Quantitative analysis for in vivo entry point and target point localization error was performed on a sub-data set of 118 procedures (1567 electrodes).RESULTS: The methodology allowed successful implantation in all cases. Major complication rate was 12 of 500 (2.4%), including 1 death for indirect morbidity. Median entry point localization error was 1.43 mm (interquartile range, 0.91-2.21 mm) with the traditional workflow and 0.78 mm (interquartile range, 0.49-1.08 mm) with the new one (P < 2.2 X 10(-16)). Median target point localization errors were 2.69 mm (interquartile range, 1.89-3.67 mm) and 1.77 mm (interquartile range, 1.25-2.51 mm; P < 2.2 X 10(-16)), respectively.CONCLUSION: SEEG is a safe and accurate procedure for the invasive assessment of the epileptogenic zone. Traditional Talairach methodology, implemented by multimodal planning and robot-assisted surgery, allows direct electrical recording from superficial and deep-seated brain structures, providing essential information in the most complex cases of drug-resistant epilepsy.