title: Stereoelectroencephalography:  surgical methodology, safety, and stereotactic application accuracy in 500 procedures.
abstract: BACKGROUND
  Stereoelectroencephalography (SEEG) methodology, originally developed by Talairach and Bancaud, is progressively gaining popularity for the presurgical invasive evaluation of drug-resistant epilepsies.
  
  
  OBJECTIVE
  To describe recent SEEG methodological implementations carried out in our center, to evaluate safety, and to analyze in vivo application accuracy in a consecutive series of 500 procedures with a total of 6496 implanted electrodes.
  
  
  METHODS
  Four hundred nineteen procedures were performed with the traditional 2-step surgical workflow, which was modified for the subsequent 81 procedures. The new workflow entailed acquisition of brain 3-dimensional angiography and magnetic resonance imaging in frameless and markerless conditions, advanced multimodal planning, and robot-assisted implantation. Quantitative analysis for in vivo entry point and target point localization error was performed on a sub--data set of 118 procedures (1567 electrodes).
  
  
  RESULTS
  The methodology allowed successful implantation in all cases. Major complication rate was 12 of 500 (2.4%), including 1 death for indirect morbidity. Median entry point localization error was 1.43 mm (interquartile range, 0.91-2.21 mm) with the traditional workflow and 0.78 mm (interquartile range, 0.49-1.08 mm) with the new one (P < 2.2 × 10). Median target point localization errors were 2.69 mm (interquartile range, 1.89-3.67 mm) and 1.77 mm (interquartile range, 1.25-2.51 mm; P < 2.2 × 10), respectively.
  
  
  CONCLUSIONS
  SEEG is a safe and accurate procedure for the invasive assessment of the epileptogenic zone. Traditional Talairach methodology, implemented by multimodal planning and robot-assisted surgery, allows direct electrical recording from superficial and deep-seated brain structures, providing essential information in the most complex cases of drug-resistant epilepsy.
authors.affiliation: Claudio Munari Centre for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milano, Italy. francesco.cardinale@ospedaleniguarda.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Cardinale
authors.forename: Massimo
authors.initials: M
authors.lastname: Cossu
authors.forename: Laura
authors.initials: L
authors.lastname: Castana
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Casaceli
authors.forename: Marco Paolo
authors.initials: MP
authors.lastname: Schiariti
authors.forename: Anna
authors.initials: A
authors.lastname: Miserocchi
authors.forename: Dalila
authors.initials: D
authors.lastname: Fuschillo
authors.forename: Alessio
authors.initials: A
authors.lastname: Moscato
authors.forename: Chiara
authors.initials: C
authors.lastname: Caborni
authors.forename: Gabriele
authors.initials: G
authors.lastname: Arnulfo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lo Russo
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001921:Brain / Q000601:surgery; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D004567:Electrodes, Implanted / Q000009:adverse effects; D004569:Electroencephalography / Q000009:adverse effects; D004827:Epilepsy / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000379:methods*; D012371:Robotics; D012449:Safety; D013238:Stereotaxic Techniques; D025321:Surgery, Computer-Assisted / Q000379:methods*; D055815:Young Adult