Subdural Electrodes for Seizure Focus Localization

Neurosurgery ◽  
1986 ◽  
Vol 19 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Thomas J. Rosenbaum ◽  
Kenneth D. Laxer ◽  
Michael Vessely ◽  
W. Brewster Smith
Keyword(s):  
Electrode Placement ◽  
Surgical Decision ◽  
Electrode Implantation ◽  
Seizure Focus ◽  
Seizure Disorders ◽  
Depth Electrodes ◽  
Subdural Electrode ◽  
Focus Localization ◽  
Significant Addition ◽  
Made In

Abstract Fifty patients with medically refractory partial seizure disorders have undergone subdural electrode placement for seizure focus localization. Standard scalp telemetry recordings of ictal events had failed to demonstrate accurately the site of seizure onset, and these patients were considered candidates for telemetry with intracerebral depth electrodes. Excellent recordings of interictal and ictal events were obtained, and localization of the epileptogenic focus was derived from recordings made during spontaneously occurring seizures. Electrocorticograms were monitored for up to 21 days. The recordings enabled a surgical decision to be made in 43 of 50 cases (86%). Thirty patients have subsequently undergone cortical excision of their foci with good results. Subdural electrode recordings are a significant addition to the armamentarium of the neurosurgeon attempting to localize surgical seizure foci, offering a low morbidity procedure as an alternative to depth electrode implantation.

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.

Depth Electrodes: Approaches and Complications

2018 ◽  
pp. 50-62
Author(s):  
Thomas Ostergard ◽  
Jonathan P. Miller
Keyword(s):  
Intracranial Haemorrhage ◽  
Electrode Placement ◽  
Frameless Stereotaxy ◽  
Electrode Implantation ◽  
Depth Electrodes ◽  
Stereotactic Frame ◽  
Electrode Length ◽  
Using Data ◽  
Intracranial Electrode ◽  
Neurosurgical Operation

Depth electrode placement is an invaluable technique in treating patients with refractory epilepsy. Like any neurosurgical operation, planning is the most important phase of the procedure. The seizure focus should first be grossly localized using data from scalp electrodes and seizure semiology. This gross localization will guide placement of invasive electrophysiological hardware. All electrode implantation methods rely on Talairach’s principles of stereotaxis. Traditional electrode implantation is performed with a stereotactic frame. Evolving techniques use frameless stereotaxy or neuroendoscopy for implantation. The most worrisome complication of electrode placement is electrode-associated intracranial haemorrhage. Electrode deviation is a much more common complication, which can be minimized by avoiding extreme insertion angles, minimizing intracranial electrode length, and maximizing entry point accuracy.

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.

Subdural electrode recordings for seizure focus localization

1989 ◽  
Vol 2 (3) ◽  
pp. 129-135 ◽  
Author(s):  
Thomas Jay Rosenbaum ◽  
Kenneth D. Laxer
Keyword(s):  
Seizure Focus ◽  
Subdural Electrode ◽  
Focus Localization

Robotic Orthogonal Implantation of Responsive Neurostimulation (RNS) Depth Electrodes in the Mesial Temporal Lobe: Case Series

2019 ◽  
Vol 19 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Alvin Y Chan ◽  
Diem Kieu Tran ◽  
Michelle R Paff ◽  
Kamran Urgun ◽  
Frank P K Hsu ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Disease Onset ◽  
Electrode Placement ◽  
Neutral Position ◽  
Initial Experience ◽  
Electrode Implantation ◽  
Depth Electrodes ◽  
Multiple Variables ◽  
Mesial Temporal Lobe

Abstract BACKGROUND Responsive neurostimulation (RNS) is a closed-loop neurostimulation modality for treating intractable epilepsy in patients who are not candidates for resection. In the past, implantation of depth electrodes was done through a transoccipital approach that transverses the hippocampus. There have been no descriptions of orthogonal approaches to RNS electrode placement. OBJECTIVE To describe our initial experience with placing RNS depth electrodes using an orthogonal approach to target the short axis of the mesial temporal lobe. METHODS Presurgical work-up included magnetic resonance imaging, video electroencephalography, and neuropsychological testing. During the procedure, patients were placed with their heads in a neutral position. Electrodes were placed via stereotactic robotic assistance using a unilateral orthogonal approach targeting the amygdala or hippocampus. Patients who underwent RNS electrode implantation via orthogonal approach were identified. Multiple variables were collected, including age, disease onset, complications, follow-up, semiology, and seizure reduction. RESULTS There were 8 patients who underwent RNS electrode placement with orthogonal approach. The mean age and follow-up were 44.8 and 1.2 yr, respectively. There were 4 patients with at least 1-yr follow-up. Of them, 1 was seizure free and 2 experienced over 50% reduction in seizures. There were no complications associated with electrode implantation. CONCLUSION The initial experience using an orthogonal approach for depth electrode placement for RNS implantation was described. The potential advantages may include better safety, accuracy, and positioning in comparison to a transoccipital approach.

Placement of subdural electrode grids for seizure focus localization in patients with a large arachnoid cyst

2007 ◽  
Vol 22 (2) ◽  
pp. 1-3 ◽  
Author(s):  
Medina C. Kushen ◽  
David Frim
Keyword(s):  
Arachnoid Cyst ◽  
Arachnoid Cysts ◽  
Electrode Arrays ◽  
Seizure Focus ◽  
Subdural Electrode ◽  
Focus Localization ◽  
Electrode Contact ◽  
The Brain ◽  
Cyst Cavity ◽  
Seizure Foci

✓Subdural electrode arrays are placed to localize seizure foci for possible resection. The procedure is usually straightforward when an electrode grid array is placed on the brain convexity but can become complicated if the surface on which the grids are applied is not convex. Arachnoid cysts can be associated with seizures, but their topography presents a challenge to standard techniques for the placement of subdural grids. The authors report on a technique for electrode grid placement that successfully localized seizure foci in the depths of arachnoid cysts in two patients. Subdural grids were placed to conform to the concave cyst cavity. They were held in place with rolled gelatin foam padding, which filled the arachnoid cyst. The padding was removed before removing the electrode grids and resecting the seizure focus. Although arachnoid cysts present a technical challenge when seizure foci are located within the cyst cavity, the technique of packing the cyst cavity with gelatin foam provides good electrode contact on the concave cyst wall, allowing adequate seizure focus localization.

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.

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.

scholarly journals Localization of musicogenic epilepsy to Heschl’s gyrus and superior temporal plane: case report

2018 ◽  
Vol 129 (1) ◽  
pp. 157-164 ◽  
Author(s):  
Yasunori Nagahama ◽  
Christopher K. Kovach ◽  
Michael Ciliberto ◽  
Charuta Joshi ◽  
Ariane E. Rhone ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Electrode Placement ◽  
Seizure Focus ◽  
Depth Electrodes ◽  
Heschl’S Gyrus ◽  
Depth Electrode ◽  
Seizure Onset Zone ◽  
Temporal Structures ◽  
Heschl's Gyrus ◽  
Musicogenic Epilepsy

Musicogenic epilepsy (ME) is an extremely rare form of the disorder that is provoked by listening to or playing music, and it has been localized to the temporal lobe. The number of reported cases of ME in which intracranial electroencephalography (iEEG) has been used for seizure focus localization is extremely small, especially with coverage of the superior temporal plane (STP) and specifically, Heschl’s gyrus (HG). The authors describe the case of a 17-year-old boy with a history of medically intractable ME who underwent iEEG monitoring that involved significant frontotemporal coverage as well as coverage of the STP with an HG depth electrode anteriorly and a planum temporale depth electrode posteriorly. Five seizures occurred during the monitoring period, and a seizure onset zone was localized to HG and the STP. The patient subsequently underwent right temporal neocortical resection, involving the STP and including HG, with preservation of the mesial temporal structures. The patient remains seizure free 1 year postoperatively. To the authors’ knowledge, this is the first reported case of ME in which the seizure focus has been localized to HG and the STP with iEEG monitoring. The authors review the literature on iEEG findings in ME, explain their approach to HG depth electrode placement, and discuss the utility of STP depth electrodes in temporal lobe epilepsy.

Insertion of subdural strip electrodes for the investigation of temporal lobe epilepsy

2007 ◽  
Vol 106 (6) ◽  
pp. 1102-1106 ◽  
Author(s):  
David A. Steven ◽  
Yuri M. Andrade-Souza ◽  
Jorge G. Burneo ◽  
Richard S. McLachlan ◽  
Andrew G. Parrent
Keyword(s):  
Surgical Technique ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Common Type ◽  
Electrode Placement ◽  
Fluoroscopic Guidance ◽  
Seizure Focus ◽  
Stereotactic Frame ◽  
Number Of Patients ◽  
Subdural Electrode

✓ Temporal lobe epilepsy (TLE) is the most common type of surgically treatable epilepsy, with a considerable number of patients needing invasive electroencephalography monitoring. The authors describe a surgical technique used in the placement of subdural strip electrodes for coverage of the temporal lobe. The electrodes are inserted through an enlarged temporooccipital bur hole using fluoroscopic guidance. With this technique, subdural electrode strips can be safely placed to cover the mesial, inferior, and lateral temporal surfaces, and the seizure focus can be lateralized and localized within the temporal lobe. The technique does not require the use of a craniotomy, stereotactic frame, or neuronavigation systems. The authors compare this technique with previous descriptions of subdural electrode placement for the evaluation of TLE.

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