• Vincent Joris, José Geraldo Ribeiro-Vaz, Patrice Finet, Riëm El Tahry, Lior M Elkaim, Christian Raftopoulos, and Susana Ferrao-Santos.
• Department of Neurosurgery, Cliniques Universitaires St-Luc, Woluwe-St-Lambert, Belgium. Electronic address: vincent.j.joris@saintluc.uclouvain.be.
• World Neurosurg. 2023 Jun 1; 174: e62e71e62-e71.

BackgroundStereoencephalography (SEEG) is becoming a widespread diagnostic procedure for drug-resistant epilepsy investigation. Techniques include frame-based and robot-assisted implantation, and more recently, frameless neuronavigated systems (FNSs). Despite its recent use, the accuracy and safety of FNS are still under investigation.ObjectiveTo assess in a prospective study the accuracy and safety of a specific FNS use for SEEG implantation.MethodsTwelve patients who underwent SEEG implantation using FNS (Varioguide [Brainlab]) were included in this study. Data were collected prospectively and included demographic data, postoperative complications, functional results, and implantation characteristics (i.e., duration and number of electrodes). Further analysis included accuracy at entry point and target using measurements of the euclidean distance between planned and actual trajectories.ResultsEleven patients underwent SEEG-FNS implantation from May 2019 to March 2020. One patient did not undergo surgery because of a bleeding disorder. The mean target deviation was 4.06 mm, and mean entry point deviation was 4.2 mm, with insular electrodes significantly more deviated. Results excluding insular electrodes showed a mean target deviation of 3.66 mm and a mean entry point deviation of 3.77 mm. No severe complications occurred; a few mild to moderate adverse events were reported (1 superficial infection, 1 seizure cluster, and 3 transient neurologic impairments). The mean implantation duration by electrodes was 18.5 minutes.ConclusionsImplantation of depth electrodes for SEEG using FNS seems to be safe, but larger prospective studies are needed to validate these results. Accuracy is sufficient for noninsular trajectories but warrant caution for insular trajectories with statistically significantly less accuracy.Copyright © 2023 Elsevier Inc. All rights reserved.

18 keywords...

hide…