Oblique trajectory angles in robotic stereoelectroencephalography

Patrick S. Rollo, Matthew J. Rollo, Ping Zhu, Oscar Woolnough, Nitin Tandon

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

OBJECTIVE Traditional stereo-electroencephalography (sEEG) entails the use of orthogonal trajectories guided by seizure semiology and arteriography. Advances in robotic stereotaxy and computerized neuronavigation have made oblique trajectories more feasible and easier to implement without formal arteriography. Such trajectories provide access to components of seizure networks not readily sampled using orthogonal trajectories. However, the dogma regarding the relative safety and predictability of orthogonal and azimuth-based trajectories persists, given the absence of data regarding the safety and efficacy of oblique sEEG trajectories. In this study, the authors evaluated the relative accuracy and efficacy of both orthogonal and oblique trajectories during robotic implantation of sEEG electrodes to sample seizure networks. METHODS The authors performed a retrospective analysis of 150 consecutive procedures in 134 patients, accounting for 2040 electrode implantations. Of these, 837 (41%) were implanted via oblique trajectories (defined as an entry angle > 30°). Accuracy was calculated by comparing the deviation of each electrode at the entry and the target point from the planned trajectory using postimplantation imaging. RESULTS The mean entry and target deviations were 1.57 mm and 1.89 mm for oblique trajectories compared with 1.38 mm and 1.69 mm for orthogonal trajectories, respectively. Entry point deviation was significantly associated with entry angle, but the impact of this relationship was negligible (-0.015-mm deviation per degree). Deviation at the target point was not significantly affected by the entry angle. No hemorrhagic or infectious complications were observed in the entire cohort, further suggesting that these differences were not meaningful in a clinical context. Of the patients who then underwent definitive procedures after sEEG, 69 patients had a minimum of 12 months of follow-up, of whom 58 (84%) achieved an Engel class I or II outcome during a median follow-up of 27 months. CONCLUSIONS The magnitude of stereotactic errors in this study falls squarely within the range reported in the sEEG literature, which primarily features orthogonal trajectories. The patient outcomes reported in this study suggest that seizure foci are well localized using oblique trajectories. Thus, the selective use of oblique trajectories in the authors’ cohort was associated with excellent safety and efficacy, with no patient incidents, and the findings support the use of oblique trajectories as an effective and safe means of investigating seizure networks.

Original languageEnglish (US)
Pages (from-to)245-254
Number of pages10
JournalJournal of neurosurgery
Volume135
Issue number1
Early online dateJul 14 2020
DOIs
StatePublished - Jul 2021
Externally publishedYes

Bibliographical note

Funding Information:
We would like to thank the clinical staff at the Texas Comprehensive Epilepsy Program?Drs. Stephen Thompson, Giridhar Kalamanagalam, Jeremy Slater, Melissa Thomas, Omotola Hope, and Sam Lhatoo?for contributing to the success of the procedures included in this study.

Publisher Copyright:
© AANS 2021.

Keywords

  • MRI-negative epilepsy
  • Medically refractory epilepsy
  • Seizures
  • Stereo-electroencephalography

Fingerprint

Dive into the research topics of 'Oblique trajectory angles in robotic stereoelectroencephalography'. Together they form a unique fingerprint.

Cite this