Operative Nuances of Stereotactic Leksell Frame-Based Depth Electrode Implantation

2017 ◽  
Vol 15 (3) ◽  
pp. 292-295 ◽  
Author(s):  
Holger Joswig ◽  
Carolyn M Benson ◽  
Andrew G Parrent ◽  
Keith W MacDougall ◽  
David A Steven
Keyword(s):  
Technical Note ◽  
Implantation Technique ◽  
Electrode Implantation ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
The World

Abstract Background For intracranial electroencephalographic monitoring, stereotactically implanted depth electrodes are increasingly used at epilepsy centers around the world. Objective To identify pearls and pitfalls from our experience with stereotactic Leksell (Elekta AB, Stockhom, Sweden) frame-based depth electrode implantation. Methods An intraoperative video of the implantation technique was recorded. Results A detailed description and a video on how to implant depth electrodes using the stereotactic Leksell frame is provided. Conclusion Neurosurgeons implanting depth electrodes for intracranial electroencephalographic monitoring might find the technical nuances and caveats described in this technical note useful for their practice.

Utility of depth electrode placement in the neurosurgical management of bottom-of-sulcus lesions: technical note

2019 ◽  
Vol 24 (3) ◽  
pp. 284-292
Author(s):  
Eisha A. Christian ◽  
Elysa Widjaja ◽  
Ayako Ochi ◽  
Hiroshi Otsubo ◽  
Stephanie Holowka ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Focal Cortical Dysplasia ◽  
Target Identification ◽  
Cortical Dysplasia ◽  
Technical Note ◽  
Electrode Placement ◽  
Electrode Implantation ◽  
Depth Electrodes ◽  
Intracranial Electrode ◽  
The Brain

OBJECTIVESmall lesions at the depth of the sulcus, such as with bottom-of-sulcus focal cortical dysplasia, are not visible from the surface of the brain and can therefore be technically challenging to resect. In this technical note, the authors describe their method of using depth electrodes as landmarks for the subsequent resection of these exacting lesions.METHODSA retrospective review was performed on pediatric patients who had undergone invasive electroencephalography with depth electrodes that were subsequently used as guides for resection in the period between July 2015 and June 2017.RESULTSTen patients (3–15 years old) met the criteria for this study. At the same time as invasive subdural grid and/or strip insertion, between 2 and 4 depth electrodes were placed using a hand-held frameless neuronavigation technique. Of the total 28 depth electrodes inserted, all were found within the targeted locations on postoperative imaging. There was 1 patient in whom an asymptomatic subarachnoid hemorrhage was demonstrated on postprocedural imaging. Depth electrodes aided in target identification in all 10 cases.CONCLUSIONSDepth electrodes placed at the time of invasive intracranial electrode implantation can be used to help localize, target, and resect primary zones of epileptogenesis caused by bottom-of-sulcus lesions.

Robotic Navigated Laser Craniotomy for Depth Electrode Implantation in Epilepsy Surgery: A Cadaver Lab Study

2020 ◽  
Author(s):  
Karl Roessler ◽  
Fabian Winter ◽  
Tobias Wilken ◽  
Ekaterina Pataraia ◽  
Magdalena Mueller-Gerbl ◽  
...  
Keyword(s):  
Laser Beam ◽  
Epilepsy Surgery ◽  
Entry Point ◽  
Occipital Bone ◽  
Electrode Placement ◽  
Target Point ◽  
Twist Drill ◽  
Electrode Implantation ◽  
Depth Electrodes ◽  
Depth Electrode

Abstract Objective Depth electrode implantation for invasive monitoring in epilepsy surgery has become a standard procedure. We describe a new frameless stereotactic intervention using robot-guided laser beam for making precise bone channels for depth electrode placement. Methods A laboratory investigation on a head cadaver specimen was performed using a CT scan planning of depth electrodes in various positions. Precise bone channels were made by a navigated robot-driven laser beam (erbium:yttrium aluminum garnet [Er:YAG], 2.94-μm wavelength,) instead of twist drill holes. Entry point and target point precision was calculated using postimplantation CT scans and comparison to the preoperative trajectory plan. Results Frontal, parietal, and occipital bone channels for bolt implantation were made. The occipital bone channel had an angulation of more than 60 degrees to the surface. Bolts and depth electrodes were implanted solely guided by the trajectory given by the precise bone channels. The mean depth electrode length was 45.5 mm. Entry point deviation was 0.73 mm (±0.66 mm SD) and target point deviation was 2.0 mm (±0.64 mm SD). Bone channel laser time was ∼30 seconds per channel. Altogether, the implantation time was ∼10 to 15 minutes per electrode. Conclusion Navigated robot-assisted laser for making precise bone channels for depth electrode implantation in epilepsy surgery is a promising new, exact and straightforward implantation technique and may have many advantages over twist drill hole implantation.

scholarly journals Stereotactic electroencephalography with temporal grid and mesial temporal depth electrode coverage: does technique of depth electrode placement affect outcome?

2010 ◽  
Vol 113 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Jamie J. Van Gompel ◽  
Fredric B. Meyer ◽  
W. Richard Marsh ◽  
Kendall H. Lee ◽  
Gregory A. Worrell
Keyword(s):  
Temporal Lobe ◽  
Middle Temporal Gyrus ◽  
Electrode Implantation ◽  
Middle Temporal ◽  
Contact Depth ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Group A ◽  
Group B ◽  
Seizure Localization

Object Intracranial monitoring for temporal lobe seizure localization to differentiate neocortical from mesial temporal onset seizures requires both neocortical subdural grids and hippocampal depth electrode implantation. There are 2 basic techniques for hippocampal depth electrode implantation. This first technique uses a stereotactically guided 8-contact depth electrode directed along the long axis of the hippocampus to the amygdala via an occipital bur hole. The second technique involves direct placement of 2 or 3 4-contact depth electrodes perpendicular to the temporal lobe through the middle temporal gyrus and overlying subdural grid. The purpose of this study was to determine whether one technique was superior to the other by examining monitoring success and complications. Methods Between 1997 and 2005, 41 patients underwent invasive seizure monitoring with both temporal subdural grids and depth electrodes placed in 2 ways. Patients in Group A underwent the first technique, and patients in Group B underwent the second technique. Results Group A consisted of 26 patients and Group B 15 patients. There were no statistically significant differences between Groups A and B regarding demographics, monitoring duration, seizure localization, or outcome (Engel classification). There was a statistically significant difference at the point in time at which these techniques were used: Group A represented more patients earlier in the series than Group B (p < 0.05). The complication rate attributable to the grids and depth electrodes was 0% in each group. It was more likely that the depth electrodes were placed through the grid if there was a prior resection and the patient was undergoing a new evaluation (p < 0.05). Furthermore, Group A procedures took significantly longer than Group B procedures. Conclusions In this patient series, there was no difference in efficacy of monitoring, complications, or outcome between hippocampal depth electrodes placed laterally through temporal grids or using an occipital bur hole stereotactic approach. Placement of the depth electrodes perpendicularly through the grids and middle temporal gyrus is technically more practical because multiple head positions and redraping are unnecessary, resulting in shorter operative times with comparable results.

scholarly journals C.T. Aided Stereotaxy for Depth Electrode Implantation and Biopsy

1983 ◽  
Vol 10 (3) ◽  
pp. 166-169 ◽  
Author(s):  
T.M. Peters ◽  
André Olivier
Keyword(s):  
Computer Program ◽  
Spike Activity ◽  
Three Dimensional ◽  
Modes Of Operation ◽  
Electrode Implantation ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Epileptic Spike

SUMMARY:We describe a computer program which facilitates the analysis of a series of C.T. scans made while a stereotaxic frame is fixed to the patient.The program has 2 modes of operation:a) The operator may select a region and determine the three-dimensional frame coordinate.b) The operator may select a set of frame coordinates and have the computer program display these at the appropriate sites on the C.T. scans. If these sites are the positions of depth electrodes, then a recording of the epileptic spike activity may be displayed at the appropriate sites on the scans.

Novel use of a custom stereotactic frame for placement of depth electrodes for epilepsy monitoring

2008 ◽  
Vol 25 (3) ◽  
pp. E20 ◽  
Author(s):  
R. Morgan Stuart ◽  
Robert R. Goodman
Keyword(s):  
Time Pressure ◽  
Electrode Implantation ◽  
Epileptiform Discharges ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Stereotactic Frame ◽  
Pin Fixation ◽  
The Right ◽  
Platform System ◽  
Epilepsy Monitoring

The authors describe the first reported application of a miniature, customized, one-time use, skull-mounted stereotactic frame for the implantation of depth electrodes for epilepsy monitoring. Using a platform template, 4 skull fiducial markers were placed 1 week prior to surgery. A brain MR image and a CT scan were subsequently obtained. All planning (longitudinal trajectories into the hippocampi) was done preoperatively using personal computers in the office. No further workstation planning was necessary on the day of the operation. The StarFix microTargeting Platform system was secured to the previously implanted skull fiducial screws. Pin fixation was not required. The platform was used to identify the area of entry for the depth electrodes on the right and left sides. On each side, a 12-contact depth electrode was advanced to the depth of the targets without difficulty. A temporal craniotomy was then performed to place subdural electrodes. The desired location of the electrodes was confirmed on postoperative imaging studies. There were no complications associated with the electrode implantation. The depth electrodes demonstrated symmetrical, robust coverage of each hippocampus, with epileptiform discharges observed bilaterally. This first application of the StarFix platform for placing depth electrodes for epilepsy monitoring was both safe and feasible. With this technique, the patient does not need to be pinned or placed in a head holder, no imaging or computer planning is required on the day of implantation (which means there is no time pressure when the meticulous target/trajectory planning is done), and with bilateral posterior implants both bur holes can be made simultaneously. For these reasons this system may be preferable to existing methods of depth electrode implantation.

Robotic image-guided depth electrode implantation in the evaluation of medically intractable epilepsy

2008 ◽  
Vol 25 (3) ◽  
pp. E19 ◽  
Author(s):  
William J. Spire ◽  
Barbara C. Jobst ◽  
Vijay M. Thadani ◽  
Peter D. Williamson ◽  
Terrance M. Darcey ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Robotic System ◽  
Electrode Placement ◽  
Seizure Onset ◽  
Electrode Implantation ◽  
Grid Electrode ◽  
Image Guided ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Time Period

Object The authors describe their experience with a technique for robotic implantation of depth electrodes in patients concurrently undergoing craniotomy and placement of subdural monitoring electrodes for the evaluation of intractable epilepsy. Methods Patients included in this study underwent evaluation in the Dartmouth Surgical Epilepsy Program and were recommended for invasive seizure monitoring with depth electrodes between 2006 and the present. In all cases an image-guided robotic system was used during craniotomy for concurrent subdural grid electrode placement. A total of 7 electrodes were placed in 4 patients within the time period. Results Three of 4 patients had successful localization of seizure onset, and 2 underwent subsequent resection. Of the patients who underwent resection, 1 is now seizure free, and the second has only auras. There was 1 complication after subpial grid placement but no complications related to the depth electrodes. Conclusions Robotic image-guided placement of depth electrodes with concurrent craniotomy is feasible, and the technique is safe, accurate, and efficient.

scholarly journals Accuracy and Workflow Improvements for Responsive Neurostimulation Hippocampal Depth Electrode Placement Using Robotic Stereotaxy

2020 ◽  
Vol 11 ◽  
Author(s):  
Patrick J. Karas ◽  
Nisha Giridharan ◽  
Jeffrey M. Treiber ◽  
Marc A. Prablek ◽  
A. Basit Khan ◽  
...  
Keyword(s):  
Prone Position ◽  
Seizure Frequency ◽  
Supine Position ◽  
Human Error ◽  
Electrode Placement ◽  
Implantation Technique ◽  
Radial Error ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Early Results

Background: Robotic stereotaxy is increasingly common in epilepsy surgery for the implantation of stereo-electroencephalography (sEEG) electrodes for intracranial seizure monitoring. The use of robots is also gaining popularity for permanent stereotactic lead implantation applications such as in deep brain stimulation and responsive neurostimulation (RNS) procedures.Objective: We describe the evolution of our robotic stereotactic implantation technique for placement of occipital-approach hippocampal RNS depth leads.Methods: We performed a retrospective review of 10 consecutive patients who underwent robotic RNS hippocampal depth electrode implantation. Accuracy of depth lead implantation was measured by registering intraoperative post-implantation fluoroscopic CT images and post-operative CT scans with the stereotactic plan to measure implantation accuracy. Seizure data were also collected from the RNS devices and analyzed to obtain initial seizure control outcome estimates.Results: Ten patients underwent occipital-approach hippocampal RNS depth electrode placement for medically refractory epilepsy. A total of 18 depth electrodes were included in the analysis. Six patients (10 electrodes) were implanted in the supine position, with mean target radial error of 1.9 ± 0.9 mm (mean ± SD). Four patients (8 electrodes) were implanted in the prone position, with mean radial error of 0.8 ± 0.3 mm. The radial error was significantly smaller when electrodes were implanted in the prone position compared to the supine position (p = 0.002). Early results (median follow-up time 7.4 months) demonstrate mean seizure frequency reduction of 26% (n = 8), with 37.5% achieving ≥50% reduction in seizure frequency as measured by RNS long episode counts.Conclusion: Prone positioning for robotic implantation of occipital-approach hippocampal RNS depth electrodes led to lower radial target error compared to supine positioning. The robotic platform offers a number of workflow advantages over traditional frame-based approaches, including parallel rather than serial operation in a bilateral case, decreased concern regarding human error in setting frame coordinates, and surgeon comfort.

Implantation of Depth Electrodes in Children Using VarioGuide® Frameless Navigation System: Technical Note

2017 ◽  
Vol 15 (3) ◽  
pp. 302-309 ◽  
Author(s):  
Marcelo Budke ◽  
Josue M Avecillas-Chasin ◽  
Francisco Villarejo
Keyword(s):  
Navigation System ◽  
Technical Note ◽  
Entry Point ◽  
Electrode Placement ◽  
Electrode Position ◽  
Electrode Implantation ◽  
Depth Electrodes ◽  
Stereotactic Navigation ◽  
The Mean ◽  
A New Technique

Abstract BACKGROUND Electrode placement in epilepsy surgery seeks to locate the sites of ictal onset and early propagation. An invasive diagnostic procedure, stereoelectroencephalography (SEEG) is usually implemented with frame-based methods that can be especially problematic in young children. OBJECTIVE To evaluate the feasibility and accuracy of a new technique for frameless SEEG in children using the VarioGuide® system (Brainlab AG, München, Germany). METHODS A frameless stereotactic navigation system was used to implant depth electrodes with percutaneous drilling and bolt insertion in pediatric patients with medically refractory epilepsy. Data on general demographic information of electrode implantation, duration, number, and complications were retrospectively collected. To determine the placement accuracy of the VarioGuide® frameless system, the mean Euclidean distances were calculated by comparing the preoperatively planned trajectories with the final electrode position observed on postoperative computed tomography scans. RESULTS From May 2011 to December 2015, 15 patients (8 males, 7 females; mean age: 8 yr, range: 3-16 yr) underwent SEEG depth electrode implantation of a total of 111 electrodes. The mean error measured by the Euclidean distance from the center of the entry point to the intended entry point was 3.64 ± 1.78 mm (range: 0.58-7.59 mm) and the tip of the electrode to the intended target was 2.96 ± 1.49 mm (range: 0.58-7.82 mm). There were no significant complications. CONCLUSION Depth electrodes can be placed safely and accurately in children using the VarioGuide® frameless stereotactic navigation system.

Stereotactic placement of depth electrodes in medically intractable epilepsy

2014 ◽  
Vol 120 (3) ◽  
pp. 639-644 ◽  
Author(s):  
Jorge Gonzalez-Martinez ◽  
Jeffrey Mullin ◽  
Sumeet Vadera ◽  
Juan Bulacio ◽  
Gwyneth Hughes ◽  
...  
Keyword(s):  
Focal Epilepsy ◽  
Cleveland Clinic ◽  
Intractable Epilepsy ◽  
Seizure Outcome ◽  
Widespread Application ◽  
Electrode Implantation ◽  
Implanted Electrodes ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Calculated Risk

Object Despite its long-reported successful record, with almost 60 years of clinical use, the technical complexity regarding the placement of stereoelectroencephalography (SEEG) depth electrodes may have contributed to the limited widespread application of the technique in centers outside Europe. The authors report on a simplified and novel SEEG surgical technique in the extraoperative mapping of refractory focal epilepsy. Methods The proposed technique was applied in patients with medically refractory focal epilepsy. Data regarding general demographic information, method of electrode implantation, time of implantation, number of implanted electrodes, seizure outcome after SEEG-guided resections, and complications were prospectively collected. Results From March 2009 to April 2012, 122 patients underwent SEEG depth electrode implantation at the Cleveland Clinic Epilepsy Center in which the authors' technique was used. There were 65 male and 57 female patients whose mean age was 33 years (range 5–68 years). The group included 21 pediatric patients (younger than 18 years). Planning and implantations were performed in a single stage. The time for planning was, on average, 33 minutes (range 20–47 minutes), and the time for implantation was, on average, 107 minutes (range 47–150 minutes). Complications related to the SEEG technique were observed in 3 patients. The calculated risk of complications per electrode was 0.18%. The seizure-free rate after SEEG-guided resections was 62% in a mean follow-up period of 12 months. Conclusions The authors report on a safe, simplified, and less time-consuming method of SEEG depth electrode implantation, using standard and widely available surgical tools, making the technique a reasonable option for extraoperative monitoring of patients with medically intractable epilepsy in centers lacking the Talairach stereotactic armamentarium.

scholarly journals Depth Electrode Guided Anterior Insulectomy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Mauricio Mandel ◽  
Layton Lamsam ◽  
Pue Farooque ◽  
Dennis Spencer ◽  
Eyiyemisi Damisah
Keyword(s):  
Right Hemisphere ◽  
Preoperative Evaluation ◽  
Epileptiform Activity ◽  
Neurological Deficits ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Patient Reported ◽  
Frontal Operculum ◽  
History Of ◽  
Electroencephalogram Eeg

Abstract The insula is well established as an epileptogenic area.1 Insular epilepsy surgery demands precise anatomic knowledge2-4 and tailored removal of the epileptic zone with careful neuromonitoring.5 We present an operative video illustrating an intracranial electroencephalogram (EEG) depth electrode guided anterior insulectomy.  We report a 17-yr-old right-handed woman with a 4-yr history of medically refractory epilepsy. The patient reported daily nocturnal ictal vocalization preceded by an indescribable feeling. Preoperative evaluation was suggestive of a right frontal-temporal onset, but the noninvasive results were discordant. She underwent a combined intracranial EEG study with a frontal-parietal grid, with strips and depth electrodes covering the entire right hemisphere. Epileptiform activity was observed in contact 6 of the anterior insula electrode. The patient consented to the procedure and to the publication of her images.  A right anterior insulectomy was performed. First, a portion of the frontal operculum was resected and neuronavigation was used for the initial insula localization. However, due to unreliable neuronavigation (ie, brain shift), the medial and anterior borders of the insular resection were guided by the depth electrode reference. The patient was discharged 3 d after surgery with no neurological deficits and remains seizure free.  We demonstrate that depth electrode guided insular surgery is a safe and precise technique, leading to an optimal outcome.

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