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J Neurosurg. 2019 May 17:1-8. doi: 10.3171/2019.2.JNS183313. [Epub ahead of print]

Increasing the accuracy of 3D EEG implantations.

Author information

1UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London.
2National Hospital for Neurology and Neurosurgery, London.
3Epilepsy Society, Chalfont St. Peter, Buckinghamshire.
4Department of Statistical Science, University College London, United Kingdom.
5"Claudio Munari" Epilepsy Surgery Centre, Ospedale Niguarda Ca' Granda, Milan, Italy.
6Centre for Medical Imaging Computing, University College London; and.
7School of Biomedical Engineering and Imaging Sciences, Kings College London, United Kingdom.


OBJECTIVEThe accuracy of stereoelectroencephalography (SEEG) electrode implantation is an important factor in maximizing its safety. The authors established a quality assurance (QA) process to aid advances in implantation accuracy.METHODSThe accuracy of three consecutive modifications of a frameless implantation technique was quantified in three cohorts comprising 22, 8, and 23 consecutive patients. The modifications of the technique aimed to increase accuracy of the bolt placement.RESULTSThe lateral shift of the axis of the implanted bolt at the level of the planned entry point was reduced from a mean of 3.0 ± 1.6 mm to 1.4 ± 0.8 mm. The lateral shift of the axis of the implanted bolt at the level of the planned target point was reduced from a mean of 3.8 ± 2.5 mm to 1.6 ± 0.9 mm.CONCLUSIONSThis QA framework helped to isolate and quantify the factors introducing inaccuracy in SEEG implantation, and to monitor ongoing accuracy and the effect of technique modifications.


EP = entry point; IQR = interquartile range; M1, M2, M3 = method 1, method 2, method 3; NHNN = National Hospital for Neurology and Neurosurgery; QA = quality assurance; SEEG; SEEG = stereoelectroencephalography; TP = target point; accuracy; epilepsy; iEP = implemented EP; iTP = distal contact of the implanted electrode; implantation; pTP = planned TP; quality assurance


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