Intracerebral depth electrode monitoring in partial epilepsy: The morbidity and efficacy of placement using magnetic resonance image-guided stereotactic surgery

Donald A. Ross, James A Brunberg, Ivo Drury, Thomas R. Henry

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

OBJECTIVE: To determine the indications for, efficacy of, and safety of depth electrode placement using magnetic resonance imaging (MRI)-guided stereotactic surgery in patients with intractable epilepsy. METHODS: We analyzed retrospectively the results of depth electrode usage in 50 consecutive patients at the University of Michigan Hospitals studied in the years 1991 through 1994, using MRI-guided stereotactic implantation, in conjunction with simultaneous subdural strip electrode recordings. RESULTS: There were no deaths, no infections, and no new neurological deficits. One small subdural hematoma adjacent to a subdural strip electrode was evacuated to prevent interference with ictal recording. Two cylindrical subdural electrodes were found to be intraparenchymal, as revealed by postoperative MRI, and were removed. One patient was unintentionally left alone briefly, and he pulled out the electrodes while confused postictally, requiring a subsequent operation for replacement. Ictal onset zones were successfully localized in 47 patients. CONCLUSION: We have found intracerebral electrode placement to be as safe as subdural strip electrode placement and have found combined depth and strip electrode monitoring to be highly effective in localizing the onset zones of complex partial seizures. Intracranial monitoring was particularly useful in the detection of a single ictal onset zone in the absence of neuroimaging abnormality and in the definitive diagnosis of bilateral independent ictal onset zones in the temporal lobe epilepsy syndrome. The specific technical aspects of the procedure that contribute to a successful outcome are reviewed. A comparison with earlier reported series suggests that MRI-guided stereotaxy and pial inspection may reduce complications of depth electrode placement.

Original languageEnglish (US)
Pages (from-to)327-334
Number of pages8
JournalNeurosurgery
Volume39
Issue number2
DOIs
StatePublished - Aug 1996
Externally publishedYes

Fingerprint

Computer-Assisted Surgery
Partial Epilepsy
Electrodes
Magnetic Resonance Spectroscopy
Morbidity
Stroke
Magnetic Resonance Imaging
Subdural Hematoma
Temporal Lobe Epilepsy
Neuroimaging
Seizures

Keywords

  • Epilepsy
  • Implanted electrodes
  • Magnetic resonance imaging
  • Seizures
  • Stereoencephalography
  • Stereotactic surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Intracerebral depth electrode monitoring in partial epilepsy : The morbidity and efficacy of placement using magnetic resonance image-guided stereotactic surgery. / Ross, Donald A.; Brunberg, James A; Drury, Ivo; Henry, Thomas R.

In: Neurosurgery, Vol. 39, No. 2, 08.1996, p. 327-334.

Research output: Contribution to journalArticle

@article{7682621aff984d988b6a1f4bf971614d,
title = "Intracerebral depth electrode monitoring in partial epilepsy: The morbidity and efficacy of placement using magnetic resonance image-guided stereotactic surgery",
abstract = "OBJECTIVE: To determine the indications for, efficacy of, and safety of depth electrode placement using magnetic resonance imaging (MRI)-guided stereotactic surgery in patients with intractable epilepsy. METHODS: We analyzed retrospectively the results of depth electrode usage in 50 consecutive patients at the University of Michigan Hospitals studied in the years 1991 through 1994, using MRI-guided stereotactic implantation, in conjunction with simultaneous subdural strip electrode recordings. RESULTS: There were no deaths, no infections, and no new neurological deficits. One small subdural hematoma adjacent to a subdural strip electrode was evacuated to prevent interference with ictal recording. Two cylindrical subdural electrodes were found to be intraparenchymal, as revealed by postoperative MRI, and were removed. One patient was unintentionally left alone briefly, and he pulled out the electrodes while confused postictally, requiring a subsequent operation for replacement. Ictal onset zones were successfully localized in 47 patients. CONCLUSION: We have found intracerebral electrode placement to be as safe as subdural strip electrode placement and have found combined depth and strip electrode monitoring to be highly effective in localizing the onset zones of complex partial seizures. Intracranial monitoring was particularly useful in the detection of a single ictal onset zone in the absence of neuroimaging abnormality and in the definitive diagnosis of bilateral independent ictal onset zones in the temporal lobe epilepsy syndrome. The specific technical aspects of the procedure that contribute to a successful outcome are reviewed. A comparison with earlier reported series suggests that MRI-guided stereotaxy and pial inspection may reduce complications of depth electrode placement.",
keywords = "Epilepsy, Implanted electrodes, Magnetic resonance imaging, Seizures, Stereoencephalography, Stereotactic surgery",
author = "Ross, {Donald A.} and Brunberg, {James A} and Ivo Drury and Henry, {Thomas R.}",
year = "1996",
month = "8",
doi = "10.1097/00006123-199608000-00018",
language = "English (US)",
volume = "39",
pages = "327--334",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Intracerebral depth electrode monitoring in partial epilepsy

T2 - The morbidity and efficacy of placement using magnetic resonance image-guided stereotactic surgery

AU - Ross, Donald A.

AU - Brunberg, James A

AU - Drury, Ivo

AU - Henry, Thomas R.

PY - 1996/8

Y1 - 1996/8

N2 - OBJECTIVE: To determine the indications for, efficacy of, and safety of depth electrode placement using magnetic resonance imaging (MRI)-guided stereotactic surgery in patients with intractable epilepsy. METHODS: We analyzed retrospectively the results of depth electrode usage in 50 consecutive patients at the University of Michigan Hospitals studied in the years 1991 through 1994, using MRI-guided stereotactic implantation, in conjunction with simultaneous subdural strip electrode recordings. RESULTS: There were no deaths, no infections, and no new neurological deficits. One small subdural hematoma adjacent to a subdural strip electrode was evacuated to prevent interference with ictal recording. Two cylindrical subdural electrodes were found to be intraparenchymal, as revealed by postoperative MRI, and were removed. One patient was unintentionally left alone briefly, and he pulled out the electrodes while confused postictally, requiring a subsequent operation for replacement. Ictal onset zones were successfully localized in 47 patients. CONCLUSION: We have found intracerebral electrode placement to be as safe as subdural strip electrode placement and have found combined depth and strip electrode monitoring to be highly effective in localizing the onset zones of complex partial seizures. Intracranial monitoring was particularly useful in the detection of a single ictal onset zone in the absence of neuroimaging abnormality and in the definitive diagnosis of bilateral independent ictal onset zones in the temporal lobe epilepsy syndrome. The specific technical aspects of the procedure that contribute to a successful outcome are reviewed. A comparison with earlier reported series suggests that MRI-guided stereotaxy and pial inspection may reduce complications of depth electrode placement.

AB - OBJECTIVE: To determine the indications for, efficacy of, and safety of depth electrode placement using magnetic resonance imaging (MRI)-guided stereotactic surgery in patients with intractable epilepsy. METHODS: We analyzed retrospectively the results of depth electrode usage in 50 consecutive patients at the University of Michigan Hospitals studied in the years 1991 through 1994, using MRI-guided stereotactic implantation, in conjunction with simultaneous subdural strip electrode recordings. RESULTS: There were no deaths, no infections, and no new neurological deficits. One small subdural hematoma adjacent to a subdural strip electrode was evacuated to prevent interference with ictal recording. Two cylindrical subdural electrodes were found to be intraparenchymal, as revealed by postoperative MRI, and were removed. One patient was unintentionally left alone briefly, and he pulled out the electrodes while confused postictally, requiring a subsequent operation for replacement. Ictal onset zones were successfully localized in 47 patients. CONCLUSION: We have found intracerebral electrode placement to be as safe as subdural strip electrode placement and have found combined depth and strip electrode monitoring to be highly effective in localizing the onset zones of complex partial seizures. Intracranial monitoring was particularly useful in the detection of a single ictal onset zone in the absence of neuroimaging abnormality and in the definitive diagnosis of bilateral independent ictal onset zones in the temporal lobe epilepsy syndrome. The specific technical aspects of the procedure that contribute to a successful outcome are reviewed. A comparison with earlier reported series suggests that MRI-guided stereotaxy and pial inspection may reduce complications of depth electrode placement.

KW - Epilepsy

KW - Implanted electrodes

KW - Magnetic resonance imaging

KW - Seizures

KW - Stereoencephalography

KW - Stereotactic surgery

UR - http://www.scopus.com/inward/record.url?scp=0029954478&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029954478&partnerID=8YFLogxK

U2 - 10.1097/00006123-199608000-00018

DO - 10.1097/00006123-199608000-00018

M3 - Article

C2 - 8832670

AN - SCOPUS:0029954478

VL - 39

SP - 327

EP - 334

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 2

ER -