Article
Accuracy of insular stereoelectroencephalography using the anterior and posterior oblique approach
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Authors
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Georgios Naros
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Sektion für funktionelle und restaurative Neurochirurgie, Tübingen, Deutschland
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Florian Grimm
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Sektion für funktionelle und restaurative Neurochirurgie, Tübingen, Deutschland
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Thomas Wuttke
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
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Sabine Rona
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
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Jürgen Honegger
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
| Published: | June 18, 2018 |
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Outline
Text
Objective: In the past years, an increasing interest in stereoelectroencephalography (SEEG) for invasive evaluation of epilepsy patients has emerged. In particular for the insular region, this is the only available method for intracranial recording. The implantation of insular SEEG electrodes, however, is still challenging. While the orthogonal approach (OA) is the shortest trajectory to the target, it results in only few contacts per electrode within the insula. In contrast, the anterior/posterior oblique approach (AOA, POA) increases the number of contacts with the risk of being more inaccurate due to the longer trajectory. In the present study, we evaluated the accuracy of the AOA and POA in targeting the insular region during SEEG implantation.
Methods: In the present study, we evaluated the accuracy of 112 SEEG electrodes implanted in 17 patients (24.7 ± 14.2 years [2.8 - 56.5], 13 female) on the postoperative 3D MRI scan. 8/17 patients received a concomitant implantation of subdural electrodes (SE). Insular electrodes (n=22) were implanted using the AOA or POA depending on the 3D anatomy of the short and long gyri. The implantation error was related to the length of the trajectory, the location of the target and the presence of SE applying an Analysis of Covariance (ANCOVA).
Results: No operative complications occurred. The mean implantation error was 1.5 ± 1.1 mm. The ANCOVA revealed no significant differences between insular and other targets (F=1.36; p=.249) or the length of the trajectory (F=.21; p=.646). However, there was a significant increase when SEEG and SE were combined (F=6.97; p=.011). AOA/POA resulted in a mean of 5.1 ± 0.8 contacts per electrode within the insula. No significance difference between the implantation in short and long gyri (F=0.11; p=.751) was found.
Conclusion: The implantation of insular electrodes via the AOA and POA is a safe and efficient approach for SEEG implantation. In our series, there was no decrease of accuracy due to the longer trajectory.
