Stereoelectroencephalography: surgical methodology, safety, and stereotactic application accuracy in 500 procedures

• Published in: Neurosurgery Vol. 72; no. 3; pp. 353 - 366
• Main Authors: Cardinale, Francesco, Cossu, Massimo, Castana, Laura, Casaceli, Giuseppe, Schiariti, Marco Paolo, Miserocchi, Anna, Fuschillo, Dalila, Moscato, Alessio, Caborni, Chiara, Arnulfo, Gabriele, Lo Russo, Giorgio
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health, Inc 01.03.2013
• Subjects: Adolescent; Adult; Algorithms; Brain - surgery; Cerebral Angiography; Child; Child, Preschool; Drug Resistance; Electrodes, Implanted - adverse effects; Electroencephalography - adverse effects; Epilepsy - diagnosis; Epilepsy - surgery; Female; Humans; Imaging, Three-Dimensional; Localization; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Neurosurgery; Neurosurgical Procedures - methods; Robotics; Safety; Stereotaxic Techniques; Surgery, Computer-Assisted - methods; Young Adult
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0b013e31827d1161

Stereoelectroencephalography (SEEG) methodology, originally developed by Talairach and Bancaud, is progressively gaining popularity for the presurgical invasive evaluation of drug-resistant epilepsies. 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. 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). 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 × 10). 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 × 10), respectively. 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.