Abstract：
Stereoencephalography (SEEG) is becoming a widespread diagnostic procedure for drug-resistant epilepsy investigation. Techniques include frame-based and robot-assisted implantation, and more recently, frameless neuronavigated systems (FNSs). Despite its recent use, the accuracy and safety of FNS are still under investigation.
To assess in a prospective study the accuracy and safety of a specific FNS use for SEEG implantation.
Twelve patients who underwent SEEG implantation using FNS (Varioguide [Brainlab]) were included in this study. Data were collected prospectively and included demographic data, postoperative complications, functional results, and implantation characteristics (i.e., duration and number of electrodes). Further analysis included accuracy at entry point and target using measurements of the euclidean distance between planned and actual trajectories.
Eleven patients underwent SEEG-FNS implantation from May 2019 to March 2020. One patient did not undergo surgery because of a bleeding disorder. The mean target deviation was 4.06 mm, and mean entry point deviation was 4.2 mm, with insular electrodes significantly more deviated. Results excluding insular electrodes showed a mean target deviation of 3.66 mm and a mean entry point deviation of 3.77 mm. No severe complications occurred; a few mild to moderate adverse events were reported (1 superficial infection, 1 seizure cluster, and 3 transient neurologic impairments). The mean implantation duration by electrodes was 18.5 minutes.
Implantation of depth electrodes for SEEG using FNS seems to be safe, but larger prospective studies are needed to validate these results. Accuracy is sufficient for noninsular trajectories but warrant caution for insular trajectories with statistically significantly less accuracy.
To assess in a prospective study the accuracy and safety of a specific FNS use for SEEG implantation.
Twelve patients who underwent SEEG implantation using FNS (Varioguide [Brainlab]) were included in this study. Data were collected prospectively and included demographic data, postoperative complications, functional results, and implantation characteristics (i.e., duration and number of electrodes). Further analysis included accuracy at entry point and target using measurements of the euclidean distance between planned and actual trajectories.
Eleven patients underwent SEEG-FNS implantation from May 2019 to March 2020. One patient did not undergo surgery because of a bleeding disorder. The mean target deviation was 4.06 mm, and mean entry point deviation was 4.2 mm, with insular electrodes significantly more deviated. Results excluding insular electrodes showed a mean target deviation of 3.66 mm and a mean entry point deviation of 3.77 mm. No severe complications occurred; a few mild to moderate adverse events were reported (1 superficial infection, 1 seizure cluster, and 3 transient neurologic impairments). The mean implantation duration by electrodes was 18.5 minutes.
Implantation of depth electrodes for SEEG using FNS seems to be safe, but larger prospective studies are needed to validate these results. Accuracy is sufficient for noninsular trajectories but warrant caution for insular trajectories with statistically significantly less accuracy.
摘要：
背景：立体脑电图（SEEG）正在成为耐药性癫痫研究的广泛诊断程序。技术包括基于框架和机器人辅助植入，最近，无框架神经系统（FNS）。尽管它最近使用，FNS的准确性和安全性仍在调查中。
目的：在一项前瞻性研究中评估特定FNS用于SEEG植入的准确性和安全性。
方法：本研究包括12例使用FNS（Varioguide®-Brainlab）进行SEEG植入的患者。数据是前瞻性收集的，包括人口统计数据，术后并发症,功能结果，和植入特征(即持续时间，电极数量)。进一步的分析包括使用计划和实际轨迹之间的欧几里得距离的测量在入口点和目标处的准确性。
结果：从2019年5月至2020年3月，有11例患者接受了SEEG-FNS植入。一名患者由于出血性疾病未接受手术。平均目标偏差为4.06mm,平均入口点偏差为4.2毫米，与岛状电极明显更偏离。不包括岛状电极的结果显示平均目标偏差为3.66mm,平均进入点偏差为3.77mm。无严重并发症发生；报告了一些轻度至中度不良事件（1例浅表感染，1次癫痫发作和3次短暂性神经损伤)。电极的平均植入时间为18.5分钟。
结论：使用FNS植入SEEG的深度电极似乎是安全的，但需要更大的前瞻性研究来验证这些结果.对于非岛状轨迹，准确性足够，但对于统计准确性明显较低的岛状轨迹，请谨慎行事。
目的：在一项前瞻性研究中评估特定FNS用于SEEG植入的准确性和安全性。
方法：本研究包括12例使用FNS（Varioguide®-Brainlab）进行SEEG植入的患者。数据是前瞻性收集的，包括人口统计数据，术后并发症,功能结果，和植入特征(即持续时间，电极数量)。进一步的分析包括使用计划和实际轨迹之间的欧几里得距离的测量在入口点和目标处的准确性。
结果：从2019年5月至2020年3月，有11例患者接受了SEEG-FNS植入。一名患者由于出血性疾病未接受手术。平均目标偏差为4.06mm,平均入口点偏差为4.2毫米，与岛状电极明显更偏离。不包括岛状电极的结果显示平均目标偏差为3.66mm,平均进入点偏差为3.77mm。无严重并发症发生；报告了一些轻度至中度不良事件（1例浅表感染，1次癫痫发作和3次短暂性神经损伤)。电极的平均植入时间为18.5分钟。
结论：使用FNS植入SEEG的深度电极似乎是安全的，但需要更大的前瞻性研究来验证这些结果.对于非岛状轨迹，准确性足够，但对于统计准确性明显较低的岛状轨迹，请谨慎行事。
