Fibrin sealant to prevent subdural electrode migration during intracranial electroencephalographic monitoring in a patient with a large arachnoid cyst

2014 ◽  
Vol 14 (1) ◽  
pp. 115-119 ◽  
Author(s):  
Alastair T. Hoyt ◽  
Peter S. LaViolette ◽  
Sean M. Lew
Keyword(s):  
Arachnoid Cyst ◽  
Fibrin Sealant ◽  
Intractable Epilepsy ◽  
Cortical Surface ◽  
Technical Challenge ◽  
Stable Position ◽  
Subdural Electrodes ◽  
Subdural Electrode ◽  
Intracranial Electrode

Ensuring a stable position of intracranial electrode grids with good proximity to the cortical surface can be a technical challenge in patients with complex anomalous cerebral anatomy. This report illustrates the use of fibrin sealant to secure subdural electrodes to concave cortical surfaces during intracranial electroencephalographic monitoring for localization-related medically intractable epilepsy in a patient with a large arachnoid cyst.

MULTI-MODALITY IMAGE REGISTRATION FOR SUBDURAL ELECTRODE LOCALIZATION

2014 ◽  
Vol 26 (05) ◽  
pp. 1450051
Author(s):  
Shuo Dong ◽  
Yuan Liu ◽  
Lixin Cai ◽  
Mei Bai ◽  
Hanmin Yan
Keyword(s):  
Image Registration ◽  
Intractable Epilepsy ◽  
Rigid Registration ◽  
Multimodal Image Registration ◽  
Subdural Electrodes ◽  
Subdural Electrode ◽  
Information Metric ◽  
Electrode Localization ◽  
Image Pairs

Surgical treatment has been proved to be an effective way to control seizures for some kinds of intractable epilepsy. The electrocorticogram (ECoG) recorded from subdural electrodes has become an important technique for defining epileptogenic zones before surgery in clinical practice. The exact location of subdural electrodes has to be determined to establish the connection between electrodes and epileptogenic zones. Artifacts caused by the electrodes can severely affect the quality of CT imaging and sequentially image registration. In this paper, we discussed the performance of mean squares and the Mattes mutual information metric methods in multimodal image registration for subdural electrode localization. Since the skull can be regarded as a rigid body, rigid registration is sufficient for the purpose of subdural electrode localization. The vital parameter for the rigid registration is rotation. The translation result depends on the result of rotation. Both the methods performed well in the determination of the rotation center. Rotation angles of different image pairs of the same volume pair fluctuated a lot. Based on the image acquisition process, we assume that the images within the same volume pair should have the same transformation parameters for registration. Results show that the mean rotation angles of images within one dataset are approximate to the manual results that are considered to be the actual result for registration despite their fluctuation range.

scholarly journals Use of an intraventricular strip electrode for mesial temporal monitoring in children with medically intractable epilepsy

2017 ◽  
Vol 19 (4) ◽  
pp. 495-501
Author(s):  
Hyunmi Kim ◽  
Ahyuda Oh ◽  
Larry Olson ◽  
Joshua J. Chern
Keyword(s):  
Intractable Epilepsy ◽  
Median Number ◽  
Seizure Onset ◽  
Strip Electrode ◽  
Subdural Electrodes ◽  
Seizure Onset Zone ◽  
Subdural Electrode ◽  
Temporal Structures ◽  
Seizure Onset Zones

OBJECTIVE The objective of this study was to evaluate mesial temporal electroencephalographic (EEG) monitoring, using an intraventricular strip electrode (IVSE) along the ventricular surface of the hippocampus, in children with medically intractable epilepsy. METHODS The authors reviewed 10 consecutive cases in which subdural electrode placements and mesial temporal monitoring were recommended. The median age of the patients was 12.7 years (range 4.5–19.3 years). Both grids and IVSE were placed in all patients. The 4-contact IVSE was used in 5 cases, and the 6-contact IVSE in the other 5 cases. The median number of contacts, including IVSE contacts, was 122 (range 66–181). A total of 182 seizures were analyzed. RESULTS The IVSE localized seizure-onset zones in 8 patients. The seizure-onset zone was identified exclusively by IVSE in 3 patients and was simultaneous in IVSE and subdural electrodes in 5 patients. Among the 5 patients with simultaneous onset on both IVSE and subdural electrodes, 4 had basal temporal onset and one had orbitofrontal and lateral midtemporal onset. In the remaining 2 patients, the absence of IVSE seizure onset permitted sparing of mesial temporal structures. An Engel Class Ia outcome was achieved in 9 of 10 cases. No complication was associated with IVSE placement. CONCLUSIONS Intracranial monitoring using IVSE offers an alternative in terms of quality of EEG recording. IVSE was useful in children who already required open craniotomy for intracranial monitoring over an extensive network of hyper-excitability.

scholarly journals Local and Distant responses to single pulse electrical stimulation reflect different forms of connectivity

2020 ◽  
Author(s):  
Britni Crocker ◽  
Lauren Ostrowski ◽  
Ziv M. Williams ◽  
Darin D. Dougherty ◽  
Emad N. Eskandar ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Resting State ◽  
Diffusion Tensor ◽  
Effective Connectivity ◽  
Clinical Care ◽  
Structural Connectivity ◽  
Intractable Epilepsy ◽  
Single Pulse ◽  
Intracranial Electrode ◽  
The Brain

AbstractBackgroundMeasuring connectivity in the human brain can involve innumerable approaches using both noninvasive (fMRI, EEG) and invasive (intracranial EEG or iEEG) recording modalities, including the use of external probing stimuli, such as direct electrical stimulation.Objective/HypothesisTo examine how different measures of connectivity correlate with one another, we compared ‘passive’ measures of connectivity during resting state conditions map to the more ‘active’ probing measures of connectivity with single pulse electrical stimulation (SPES).MethodsWe measured the network engagement and spread of the cortico-cortico evoked potential (CCEP) induced by SPES at 53 total sites across the brain, including cortical and subcortical regions, in patients with intractable epilepsy (N=11) who were undergoing intracranial recordings as a part of their clinical care for identifying seizure onset zones. We compared the CCEP network to functional, effective, and structural measures of connectivity during a resting state in each patient. Functional and effective connectivity measures included correlation or Granger causality measures applied to stereoEEG (sEEGs) recordings. Structural connectivity was derived from diffusion tensor imaging (DTI) acquired before intracranial electrode implant and monitoring (N=8).ResultsThe CCEP network was most similar to the resting state voltage correlation network in channels near to the stimulation location. In contrast, the distant CCEP network was most similar to the DTI network. Other connectivity measures were not as similar to the CCEP network.ConclusionsThese results demonstrate that different connectivity measures, including those derived from active stimulation-based probing, measure different, complementary aspects of regional interrelationships in the brain.

Interhemispheric Subdural Electrodes: Technique, Utility, and Safety

2013 ◽  
Vol 73 (2) ◽  
pp. ons253-ons260 ◽  
Author(s):  
Tarek Abuelem ◽  
David Elliot Friedman ◽  
Satish Agadi ◽  
Angus A. Wilfong ◽  
Daniel Yoshor
Keyword(s):  
Patient Monitoring ◽  
Intractable Epilepsy ◽  
Mass Effect ◽  
Neurological Deficits ◽  
Epileptic Focus ◽  
Epileptogenic Zone ◽  
Invasive Monitoring ◽  
Cortical Function ◽  
Subdural Electrodes ◽  
Dorsolateral Cortex

Abstract BACKGROUND: Invasive monitoring using subdural electrodes is often valuable for characterizing the anatomic source of seizures in intractable epilepsy. Covering the interhemispheric surface with subdural electrodes represents a particular challenge, with a potentially higher risk of complications than covering the dorsolateral cortex. OBJECTIVE: To better understand the safety and utility of interhemispheric subdural electrodes (IHSE). METHODS: We retrospectively reviewed the charts of 24 patients who underwent implantation of IHSE by a single neurosurgeon from 2003 to 2010. Generous midline exposure, meticulous preservation of veins, and sharp microdissection were used to facilitate safe interhemispheric grid placement under direct visualization. RESULTS: The number of IHSE contacts implanted ranged from 10 to 106 (mean = 39.8) per patient. Monitoring lasted for 5.5 days on average (range, 2-24 days), with an adequate sample of seizures captured in all patients before explantation, and with a low complication rate similar to that reported for grid implantation of the dorsolateral cortex. One patient (of 24) experienced symptomatic mass effect. No other complications clearly related to grid implantation and monitoring, such as clinically evident neurological deficits, infection, hematoma, or infarction, were noted. Among patients implanted with IHSE, monitoring led to a paramedian cortical resection in 67%, a resection in a region not covered by IHSE in 17%, and explantation without resection in 17%. CONCLUSION: When clinical factors suggest the possibility of an epileptic focus at or near the midline, invasive monitoring of the paramedian cortex with interhemispheric grids can be safely used to define the epileptogenic zone and map local cortical function.

Basal Temporal Subdural Electrodes in the Evaluation of Patients with Intractable Epilepsy

Epilepsia ◽  
1989 ◽  
Vol 30 (2) ◽  
pp. 131-142 ◽  
Author(s):  
Hans Lüders ◽  
Joseph Hahn ◽  
Ronald P. Lesser ◽  
Dudley S. Dinner ◽  
Harold H. Morris III ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Subdural Electrodes

Neuronavigation applied to epilepsy monitoring with subdural electrodes

2008 ◽  
Vol 25 (3) ◽  
pp. E21 ◽  
Author(s):  
Roukoz B. Chamoun ◽  
Vikram V. Nayar ◽  
Daniel Yoshor
Keyword(s):  
Functional Neuroimaging ◽  
Intractable Epilepsy ◽  
Epileptic Focus ◽  
Epileptogenic Zone ◽  
Navigation Systems ◽  
Mr Images ◽  
Subdural Electrodes ◽  
Accurate Localization ◽  
Patients With Epilepsy ◽  
Neuroimaging Techniques

Accurate localization of the epileptogenic zone is of paramount importance in epilepsy surgery. Despite the availability of noninvasive structural and functional neuroimaging techniques, invasive monitoring with subdural electrodes is still often indicated in the management of intractable epilepsy. Neuronavigation is widely used to enhance the accuracy of subdural grid placement. It allows accurate implantation of the subdural electrodes based on hypotheses formed as a result of the presurgical workup, and can serve as a helpful tool for resection of the epileptic focus at the time of grid explantation. The authors describe 2 additional simple and practical techniques that extend the usefulness of neuronavigation in patients with epilepsy undergoing monitoring with subdural electrodes. One technique involves using the neuronavigation workstation to merge preimplantation MR images with a postimplantation CT scan to create useful images for accurate localization of electrode locations after implantation. A second technique involves 4 holes drilled at the margins of the craniotomy at the time of grid implantation; these are used as fiducial markers to realign the navigation system to the original registration and allow navigation with the merged image sets at the time of reoperation for grid removal and resection of the epileptic focus. These techniques use widely available commercial navigation systems and do not require additional devices, software, or computer skills. The pitfalls and advantages of these techniques compared to alternatives are discussed.

Recursive grid partitioning on a cortical surface model: an optimized technique for the localization of implanted subdural electrodes

2013 ◽  
Vol 118 (5) ◽  
pp. 1086-1097 ◽  
Author(s):  
Thomas A. Pieters ◽  
Christopher R. Conner ◽  
Nitin Tandon
Keyword(s):  
Recursive Partitioning ◽  
Electrode Array ◽  
Ct Scans ◽  
Surface Model ◽  
Cortical Surface ◽  
Grid Partitioning ◽  
Subdural Electrodes ◽  
Postoperative Mri ◽  
Accurate Localization ◽  
Brain Surface

Object Precise localization of subdural electrodes (SDEs) is essential for the interpretation of data from intracranial electrocorticography recordings. Blood and fluid accumulation underneath the craniotomy flap leads to a nonlinear deformation of the brain surface and of the SDE array on postoperative CT scans and adversely impacts the accurate localization of electrodes located underneath the craniotomy. Older methods that localize electrodes based on their identification on a postimplantation CT scan with coregistration to a preimplantation MR image can result in significant problems with accuracy of the electrode localization. The authors report 3 novel methods that rely on the creation of a set of 3D mesh models to depict the pial surface and a smoothed pial envelope. Two of these new methods are designed to localize electrodes, and they are compared with 6 methods currently in use to determine their relative accuracy and reliability. Methods The first method involves manually localizing each electrode using digital photographs obtained at surgery. This is highly accurate, but requires time intensive, operator-dependent input. The second uses 4 electrodes localized manually in conjunction with an automated, recursive partitioning technique to localize the entire electrode array. The authors evaluated the accuracy of previously published methods by applying the methods to their data and comparing them against the photograph-based localization. Finally, the authors further enhanced the usability of these methods by using automatic parcellation techniques to assign anatomical labels to individual electrodes as well as by generating an inflated cortical surface model while still preserving electrode locations relative to the cortical anatomy. Results The recursive grid partitioning had the least error compared with older methods (672 electrodes, 6.4-mm maximum electrode error, 2.0-mm mean error, p < 10−18). The maximum errors derived using prior methods of localization ranged from 8.2 to 11.7 mm for an individual electrode, with mean errors ranging between 2.9 and 4.1 mm depending on the method used. The authors also noted a larger error in all methods that used CT scans alone to localize electrodes compared with those that used both postoperative CT and postoperative MRI. The large mean errors reported with these methods are liable to affect intermodal data comparisons (for example, with functional mapping techniques) and may impact surgical decision making. Conclusions The authors have presented several aspects of using new techniques to visualize electrodes implanted for localizing epilepsy. The ability to use automated labeling schemas to denote which gyrus a particular electrode overlies is potentially of great utility in planning resections and in corroborating the results of extraoperative stimulation mapping. Dilation of the pial mesh model provides, for the first time, a sense of the cortical surface not sampled by the electrode, and the potential roles this “electrophysiologically hidden” cortex may play in both eloquent function and seizure onset.

Combining stereo-electroencephalography and subdural electrodes in the diagnosis and treatment of medically intractable epilepsy

2014 ◽  
Vol 21 (8) ◽  
pp. 1441-1445 ◽  
Author(s):  
Rei Enatsu ◽  
Juan Bulacio ◽  
Imad Najm ◽  
Elaine Wyllie ◽  
Norman K. So ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Diagnosis And Treatment ◽  
Subdural Electrodes

scholarly journals Intraoperative computed tomography for intracranial electrode implantation surgery in medically refractory epilepsy

2015 ◽  
Vol 122 (3) ◽  
pp. 526-531 ◽  
Author(s):  
Darrin J. Lee ◽  
Marike Zwienenberg-Lee ◽  
Masud Seyal ◽  
Kiarash Shahlaie
Keyword(s):  
Wound Closure ◽  
Refractory Epilepsy ◽  
Ct Scans ◽  
Surgical Team ◽  
Electrode Implantation ◽  
Mri Studies ◽  
Subdural Electrode ◽  
Intracranial Electrode ◽  
Epilepsy Monitoring ◽  
Medically Refractory Epilepsy

OBJECT Accurate placement of intracranial depth and subdural electrodes is important in evaluating patients with medically refractory epilepsy for possible resection. Confirming electrode locations on postoperative CT scans does not allow for immediate replacement of malpositioned electrodes, and thus revision surgery is required in select cases. Intraoperative CT (iCT) using the Medtronic O-arm device has been performed to detect electrode locations in deep brain stimulation surgery, but its application in epilepsy surgery has not been explored. In the present study, the authors describe their institutional experience in using the O-arm to facilitate accurate placement of intracranial electrodes for epilepsy monitoring. METHODS In this retrospective study, the authors evaluated consecutive patients who had undergone subdural and/or depth electrode implantation for epilepsy monitoring between November 2010 and September 2012. The O-arm device is used to obtain iCT images, which are then merged with the preoperative planning MRI studies and reviewed by the surgical team to confirm final positioning. Minor modifications in patient positioning and operative field preparation are necessary to safely incorporate the O-arm device into routine intracranial electrode implantation surgery. The device does not obstruct surgeon access for bur hole or craniotomy surgery. Depth and subdural electrode locations are easily identified on iCT, which merge with MRI studies without difficulty, allowing the epilepsy surgical team to intraoperatively confirm lead locations. RESULTS Depth and subdural electrodes were implanted in 10 consecutive patients by using routine surgical techniques together with preoperative stereotactic planning and intraoperative neuronavigation. No wound infections or other surgical complications occurred. In one patient, the hippocampal depth electrode was believed to be in a suboptimal position and was repositioned before final wound closure. Additionally, 4 strip electrodes were replaced due to suboptimal positioning. Postoperative CT scans did not differ from iCT studies in the first 3 patients in the series and thus were not obtained in the final 7 patients. Overall, operative time was extended by approximately 10–15 minutes for O-arm positioning, less than 1 minute for image acquisition, and approximately 10 minutes for image transfer, fusion, and intraoperative analysis (total time 21–26 minutes). CONCLUSIONS The O-arm device can be easily incorporated into routine intracranial electrode implantation surgery in standard-sized operating rooms. The technique provides accurate 3D visualization of depth and subdural electrode contacts, and the intraoperative images can be easily merged with preoperative MRI studies to confirm lead positions before final wound closure. Intraoperative CT obviates the need for routine postoperative CT and has the potential to improve the accuracy of intracranial electroencephalography recordings and may reduce the necessity for revision surgery.

scholarly journals Minimal Tissue Reaction after Chronic Subdural Electrode Implantation for Fully Implantable Brain–Machine Interfaces

Sensors ◽  
2020 ◽  
Vol 21 (1) ◽  
pp. 178
Author(s):  
Tianfang Yan ◽  
Seiji Kameda ◽  
Katsuyoshi Suzuki ◽  
Taro Kaiju ◽  
Masato Inoue ◽  
...  
Keyword(s):  
Tissue Reaction ◽  
Tissue Response ◽  
Brain Machine Interfaces ◽  
Electrode Implantation ◽  
Subdural Electrodes ◽  
Tissue Proliferation ◽  
Significant Difference ◽  
Subdural Electrode ◽  
Cell Densities

There is a growing interest in the use of electrocorticographic (ECoG) signals in brain–machine interfaces (BMIs). However, there is still a lack of studies involving the long-term evaluation of the tissue response related to electrode implantation. Here, we investigated biocompatibility, including chronic tissue response to subdural electrodes and a fully implantable wireless BMI device. We implanted a half-sized fully implantable device with subdural electrodes in six beagles for 6 months. Histological analysis of the surrounding tissues, including the dural membrane and cortices, was performed to evaluate the effects of chronic implantation. Our results showed no adverse events, including infectious signs, throughout the 6-month implantation period. Thick connective tissue proliferation was found in the surrounding tissues in the epidural space and subcutaneous space. Quantitative measures of subdural reactive tissues showed minimal encapsulation between the electrodes and the underlying cortex. Immunohistochemical evaluation showed no significant difference in the cell densities of neurons, astrocytes, and microglia between the implanted sites and contralateral sites. In conclusion, we established a beagle model to evaluate cortical implantable devices. We confirmed that a fully implantable wireless device and subdural electrodes could be stably maintained with sufficient biocompatibility in vivo.

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