Artikel
Integrating anatomical and functional imaging and surgical neuronavigation in the comprehensive treatment of patients with drug-resistant epilepsy: first experience with frameless stereotaxy using the Vogele-Bale-Hohner (VBH) – vacuum mouthpiece and headholder
Integration von multimodalem Neuroimaging und Neuronavigation in der Behandlung von Patienten mit pharmacoresistenter Epilepsie: erste Erfahrungen mit der rahmenlosen Stereotaxie unter Verwendung von Vogele-Bale-Hohner (VBH)-Vakuum-Mundstück und -Kopfhalterung
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Autoren
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M. Ortler
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck
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E. Trinka
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Innsbruck
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G. Walser
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Innsbruck
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R. Bauer
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck
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K. Twerdy
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck
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R. Bale
- Universitätsklinik für Radiologie I, Medizinische Universität Innsbruck, Innsbruck
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
Text
Objective
Success in the surgical treatment of drug-resistant epilepsy depends on the definition of the seizure onset zone. Both image fusion during presurgical evaluation and planning of surgery require the repeated positioning of the patient for different imaging methods, the convergence of different imaging protocols for image fusion, and the use of different navigational tools to target lesions invasively.
We present preliminary information using a frame attached to a vacuum mouthpiece in order to integrate data generated during presurgical imaging and requirements of intraoperative neuronavigation in patients undergoing evaluation and therapy within a comprehensive epilepsy surgery program.
Methods
Of 111 patients undergoing surgery for epilepsy within five years in the Innsbruck Epilepsy Surgery Program (INES), 19 underwent implantation of electrodes for invasive seizure recording. All 14 foramen ovale electrodes (seven patients), and two intrahippocampal and one intralesional depth electrode (two patients) were placed by using the Vogele-Bale-Hohner (VBH) headholder and mouthpiece combined with a special removable frame and standard methods of frameless stereotaxy. Three patients underwent resective surgery employing the same system for navigational purposes: one patient with a frontal cavernoma, one patient with a zone of focal hyperactivity in the ictal SPECTwithout lesion, and one patient with a frontal hamartoma.
Results
Placement of electrodes through the foramen ovale with patients under general anesthesia was successful in all patients. In six of seven patients, the intervention was planned the day before surgery. In one patient without teeth, the intervention required an intraoperative CT scan for planning purposes. All depth electrodes were placed correctly in their respective targets. Resective surgery was successful in all three patients (Engel Class I). Temporary buccal numbness was seen in three patients with foramen ovale electrodes, and a small subcortical hematoma was observed in the patient with intrahippocampal depth electrodes. Status epilepticus in one patient after resective surgery required a prologed period of intensive care.
Conclusions
The VBH system allows the integration of anatomical and functional data into a homogeneous data set for diagnostic purposes. In addition, it is a minimally invasive, simple and fast tool for neuronavigation purposes. This might be useful in the context of epilepsy surgery.
