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. 2021 May;163(5):1355-1364.
doi: 10.1007/s00701-021-04755-w. Epub 2021 Feb 13.

VarioGuide® frameless neuronavigation-guided stereoelectroencephalography in adult epilepsy patients: technique, accuracy and clinical experience

Barbara Ladisich #  1 , Lukas Machegger #  2 , Alexander Romagna  1   3 , Herbert Krainz  1 , Jürgen Steinbacher  2 , Markus Leitinger  4 , Gudrun Kalss  4 , Niklas Thon  5 , Eugen Trinka  4 , Peter A Winkler  1 , Christoph Schwartz  6
Affiliations

VarioGuide® frameless neuronavigation-guided stereoelectroencephalography in adult epilepsy patients: technique, accuracy and clinical experience

Barbara Ladisich et al. Acta Neurochir (Wien). 2021 May.

Abstract

Background: Stereoelectroencephalography (SEEG) allows the identification of deep-seated seizure foci and determination of the epileptogenic zone (EZ) in drug-resistant epilepsy (DRE) patients. We evaluated the accuracy and treatment-associated morbidity of frameless VarioGuide® (VG) neuronavigation-guided depth electrode (DE) implantations.

Methods: We retrospectively identified all consecutive adult DRE patients, who underwent VG-neuronavigation DE implantations, between March 2013 and April 2019. Clinical data were extracted from the electronic patient charts. An interdisciplinary team agreed upon all treatment decisions. We performed trajectory planning with iPlan® Cranial software and DE implantations with the VG system. Each electrode's accuracy was assessed at the entry (EP), the centre (CP) and the target point (TP). We conducted correlation analyses to identify factors associated with accuracy.

Results: The study population comprised 17 patients (10 women) with a median age of 32.0 years (range 21.0-54.0). In total, 220 DEs (median length 49.3 mm, range 25.1-93.8) were implanted in 21 SEEG procedures (range 3-16 DEs/surgery). Adequate signals for postoperative SEEG were detected for all but one implanted DEs (99.5%); in 15/17 (88.2%) patients, the EZ was identified and 8/17 (47.1%) eventually underwent focus resection. The mean deviations were 3.2 ± 2.4 mm for EP, 3.0 ± 2.2 mm for CP and 2.7 ± 2.0 mm for TP. One patient suffered from postoperative SEEG-associated morbidity (i.e. conservatively treated delayed bacterial meningitis). No mortality or new neurological deficits were recorded.

Conclusions: The accuracy of VG-SEEG proved sufficient to identify EZ in DRE patients and associated with a good risk-profile. It is a viable and safe alternative to frame-based or robotic systems.

Keywords: Accuracy; Clinical outcome; Depth electrode; Drug-resistant epilepsy; Epilepsy surgery; Pre-surgical evaluation; SEEG.

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Conflict of interest statement

Herbert Krainz has a paid consultancy contract with BrainLab AG, Germany. All other authors have no personal or financial interest in any of devices described in this article.

Figures

Fig. 1
Fig. 1
Exemplary accuracy measurement of centre point deviation. The Euclidean distance from the planned preoperative trajectory to the placed electrode in postoperative MRI is demonstrated for the centre point (CP) of a single electrode
Fig. 2
Fig. 2
Target point deviations of all performed SEEG procedures
Fig. 3
Fig. 3
Measured EP, CP and TP deviations for an exemplary patient
See this image and copyright information in PMC

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