VarioGuide® frameless neuronavigation-guided stereoelectroencephalography in adult epilepsy patients: technique, accuracy and clinical experience
Autor: | Barbara Ladisich, Gudrun Kalss, Eugen Trinka, Christoph Schwartz, Markus Leitinger, Niklas Thon, Peter A Winkler, Jürgen Steinbacher, Lukas Machegger, Herbert Krainz, Alexander Romagna |
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Rok vydání: | 2021 |
Předmět: |
Adult
Male medicine.medical_specialty Neurology Neuronavigation SEEG Drug-resistant epilepsy Stereoelectroencephalography Stereotaxic Techniques Young Adult Epilepsy Epilepsy surgery medicine Humans Postoperative Period Depth electrode Accuracy Retrospective Studies Neuroradiology Original Article - Functional Neurosurgery - Epilepsy medicine.diagnostic_test Clinical outcome business.industry Electroencephalography Interventional radiology Middle Aged Pre-surgical evaluation medicine.disease Electrodes Implanted Treatment Outcome Female Surgery Neurology (clinical) Neurosurgery Morbidity Nuclear medicine business |
Zdroj: | Acta Neurochirurgica |
ISSN: | 0942-0940 0001-6268 |
DOI: | 10.1007/s00701-021-04755-w |
Popis: | Background Stereoelectroencephalography (SEEG) allows the identification of deep-seated seizure foci and determination of the epileptogenic zone (EZ) in drug-resistant epilepsy (DRE) patients. We evaluated the accuracy and treatment-associated morbidity of frameless VarioGuide® (VG) neuronavigation-guided depth electrode (DE) implantations. Methods We retrospectively identified all consecutive adult DRE patients, who underwent VG-neuronavigation DE implantations, between March 2013 and April 2019. Clinical data were extracted from the electronic patient charts. An interdisciplinary team agreed upon all treatment decisions. We performed trajectory planning with iPlan® Cranial software and DE implantations with the VG system. Each electrode’s accuracy was assessed at the entry (EP), the centre (CP) and the target point (TP). We conducted correlation analyses to identify factors associated with accuracy. Results The study population comprised 17 patients (10 women) with a median age of 32.0 years (range 21.0–54.0). In total, 220 DEs (median length 49.3 mm, range 25.1–93.8) were implanted in 21 SEEG procedures (range 3–16 DEs/surgery). Adequate signals for postoperative SEEG were detected for all but one implanted DEs (99.5%); in 15/17 (88.2%) patients, the EZ was identified and 8/17 (47.1%) eventually underwent focus resection. The mean deviations were 3.2 ± 2.4 mm for EP, 3.0 ± 2.2 mm for CP and 2.7 ± 2.0 mm for TP. One patient suffered from postoperative SEEG-associated morbidity (i.e. conservatively treated delayed bacterial meningitis). No mortality or new neurological deficits were recorded. Conclusions The accuracy of VG-SEEG proved sufficient to identify EZ in DRE patients and associated with a good risk-profile. It is a viable and safe alternative to frame-based or robotic systems. |
Databáze: | OpenAIRE |
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