Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Clinical Applicability and Safety of Conventional Frame-Based Stereotactic Techniques for Stereoelectroencephalography

  • Junhyung Kim (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seok Ho Hong (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hyun-Jin Kim (Division of Pediatric Neurology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Mi-Sun Yum (Division of Pediatric Neurology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Tae Sung Ko (Division of Pediatric Neurology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Yong Seo Koo (Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sang-Ahm Lee (Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2023.12.18
  • Accepted : 2024.04.26
  • Published : 2024.11.01
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Abstract

Objective : Stereoelectroencephalography (SEEG) is increasingly being recognized as an important invasive modality for presurgical evaluation of epilepsy. This study focuses on the clinical and technical considerations of SEEG investigations when using conventional frame-based stereotaxy, drawing on institutional experience and a comprehensive review of relevant literature. Methods : This retrospective observational study encompassed the surgical implantation of 201 SEEG electrodes in 16 epilepsy patients using a frame-based stereotactic instrument at a single tertiary-level center. We provide detailed descriptions of the operative procedures and technical nuances for bilateral and multiple SEEG insertions, along with several illustrative cases. Additionally, we present a literature review on the technical aspects of the SEEG procedure, discussing its clinical implications and potential risks. Results : Frame-based SEEG electrode placements were successfully performed through sagittal arc application, with the majority (81.2%) of cases being bilateral and involving up to 18 electrodes in a single operation. The median skin-to-skin operation time was 162 minutes (interquartile range [IQR], 145-200), with a median of 13 minutes (IQR, 12-15) per electrode placement for time efficiency. There were two occurrences (1.0%) of electrode misplacement and one instance (0.5%) of a postoperative complication, which manifested as a delayed intraparenchymal hemorrhage. Following SEEG investigation, 11 patients proceeded with surgical intervention, resulting in favorable seizure outcomes for nine (81.8%) and complete remission for eight cases (72.7%). Conclusion : Conventional frame-based stereotactic techniques remain a reliable and effective option for bilateral and multiple SEEG electrode placements. While SEEG is a suitable approach for selected patients who are strong candidates for epilepsy surgery, it is important to remain vigilant concerning the potential risks of electrode misplacement and hemorrhagic complications.

Keywords

References

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