• World Neurosurg · Mar 2021

    On the Use of Digital Subtraction Angiography in Stereoelectroencephalography Surgical Planning to Prevent Collisions with Vessels.

    • Ignacio Delgado-Martínez, Laura Serrano, Alfredo Higueras-Esteban, Elio Vivas, Rodrigo Rocamora, Miguel A González Ballester, Luis Serra, and Gerardo Conesa.
    • Epilepsy Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; Galgo Medical, SL, Barcelona, Spain. Electronic address: ignacio@delgado.com.
    • World Neurosurg. 2021 Mar 1; 147: e47-e56.

    ObjectiveStereoelectroencephalography (SEEG) consists of the implantation of microelectrodes for the electrophysiological characterization of epileptogenic networks. To reduce a possible risk of intracranial bleeding by vessel rupture during the electrode implantation, the stereotactic trajectories must follow avascular corridors. The use of digital subtraction angiography (DSA) for vascular visualization during planning is controversial due to the additional risk related to this procedure. Here we evaluate the utility of this technique for planning when the neurosurgeon has it available together with gadolinium-enhanced T1-weighted magnetic resonance sequence (T1-Gd) and computed tomography angiography (CTA).MethodsTwenty-two implantation plans for SEEG were initially done using T1-Gd imaging (251 trajectories). DSA was only used later during the revision process. In 6 patients CTA was available at this point as well. We quantified the position of the closest vessel to the trajectory in each of the imaging modalities.ResultsTwo thirds of the trajectories that appeared vessel free in the T1-Gd or CTA presented vessels in their proximity, as shown by DSA. Those modifications only required small shifts of both the entry and target point, so the diagnostic aims were preserved.ConclusionsT1-Gd and CTA, despite being the most commonly used techniques for SEEG planning, frequently fail to reveal vessels that are dangerously close to the trajectories. Higher-resolution vascular imaging techniques, such as DSA, can provide the neurosurgeon with crucial information about vascular anatomy, resulting in safer plans.Copyright © 2020 Elsevier Inc. All rights reserved.

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