A Frameless Stereotactic Implantation Technique for Depth Electrodes in Refractory Epilepsy Using Intraoperative Magnetic Resonance Imaging

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• 作者：Karl Roessler¹ ; ^{karl.roessler@uk-erlangen.de" class="auth_mail" title="E-mail the corresponding author} ; Bjö ; rn Sommer¹ ; Andreas Merkel¹ ; Stefan Rampp¹ ; Stephanie Gollwitzer² ; Hajo M. Hamer² ; Michael Buchfelder¹
• 关键词：Depth electrode placement ; Epilepsy surgery ; Frameless stereotactic technique ; Intraoperative MRI ; Stereo-electroencephalography
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：94
• 期：Complete
• 页码：206-210
• 全文大小：1600 K

文摘

Various complex techniques for depth electrode insertion in refractory epilepsy using preoperative imaging have been investigated. We evaluated a simple, accurate, cost-effective, and timesaving method using intraoperative magnetic resonance imaging (MRI).

Methods

A neuronavigation-guided insertion tube attached to bone facilitated the placement of stereotactic percutaneous drill holes, bolt implantation, and frameless stereotactic insertion of depth electrodes. Image registration was carried out by head coil fiducials with trajectory planning and intraoperative electrode correction.

Results

In 6 patients with refractory epilepsy (3 women and 3 men; mean age, 30.0 years; range, 20–37 years), 58 depth electrodes (9–11 per patient) were placed. The mean length of the inserted electrodes was 37.3 mm ± 8.8 (mean ± SD) (range, 22.1–84.4 mm). The overall target point accuracy was 3.2 mm ± 2.2 (range, 0–8.6 mm), which was significantly different from the overall entry point accuracy of 1.4 mm ± 1.2 (P < 0.0001). All electrodes functioned perfectly, enabling high-quality stereo-electroencephalography recordings over a period of 7.3 days ± 0.5 (range, 7–8 days). The mean implantation time for 9–11 electrodes per patient was 115 minutes ± 36.3 (range, 75–160 minutes; 12 minutes for 1 electrode on average) including the intraoperative MRI (T1 three-dimensional magnetization-prepared rapid acquisition gradient echo, T2, and diffusion tensor imaging). There was no hemorrhage, infection, or neurologic deficit related to the procedure.

Conclusions

Our frameless technique of depth electrode insertion using intraoperative MRI guidance is an accurate, reliable, cost-effective, and timesaving method for stereo-electroencephalography.