Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2019; 80(05): 353-358
DOI: 10.1055/s-0039-1685193

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Simultaneous Frame-assisted Stereotactic Placement of Subdural Grid Electrodes and Intracerebral Depth Electrodes

Peter C. Reinacher

¹Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg, Germany

²Medical Faculty, Freiburg University, Freiburg, Germany

,

Dirk-Matthias Altenmüller

²Medical Faculty, Freiburg University, Freiburg, Germany

³Department of Epileptology, Freiburg University Medical Center, Freiburg, Germany

,

Marie T. Krüger

²Medical Faculty, Freiburg University, Freiburg, Germany

⁴Department of Neurosurgery, Freiburg University Medical Center, Freiburg, Germany

,

Andreas Schulze-Bonhage

²Medical Faculty, Freiburg University, Freiburg, Germany

³Department of Epileptology, Freiburg University Medical Center, Freiburg, Germany

,

Horst Urbach

²Medical Faculty, Freiburg University, Freiburg, Germany

⁵Department of Neuroradiology, Freiburg University Medical Center, Freiburg, Germany

,

Michael Trippel

¹Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg, Germany

²Medical Faculty, Freiburg University, Freiburg, Germany

,

Volker A. Coenen

¹Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg, Germany

²Medical Faculty, Freiburg University, Freiburg, Germany

,

Daniel Delev

²Medical Faculty, Freiburg University, Freiburg, Germany

⁴Department of Neurosurgery, Freiburg University Medical Center, Freiburg, Germany

› Author Affiliations

Abstract

Background and Study Aims In complex cases of drug-resistant focal epilepsy, the precise localization of the epileptogenic zone requires simultaneous implantation of depth and subdural grid electrodes. This study describes a new simple frame-assisted method that facilitates the simultaneous placement of both types of intracranial electrodes.

Material and Methods Ten consecutive patients were evaluated and divided into two groups. Group A included patients with simultaneous frame-assisted placement of depth and subdural grid electrodes. In group B, depth electrodes were implanted stereotactically; grid electrodes were implanted in a separate surgery.

Results The placement of the subdural grid was accurate as individually designed by the epileptologists in all five patients from group A. In group B, one patient showed a slight and another one a significant deviation of the subdural grid position postoperatively. The mean surgical time in group A was shorter (280±62 minutes) compared with the mean duration of the surgical procedures in group B (336±51 minutes).

Conclusion The frame-assisted placement of subdural grid electrodes facilitates the surgical procedure for invasive video-electroencephalography monitoring in complex cases of drug-resistant focal epilepsy in which a combination of depth electrodes and subdural grid electrodes is needed, by reducing the surgical time and guaranteeing highly accurate electrode localizations.

Keywords

Keywords

depth electrodes - epilepsy - stereotactic - subdural grid

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