title: Stereotactic placement of depth electrodes in medically intractable epilepsy.
abstract: OBJECTIVE
  Despite its long-reported successful record, with almost 60 years of clinical use, the technical complexity regarding the placement of stereoelectroencephalography (SEEG) depth electrodes may have contributed to the limited widespread application of the technique in centers outside Europe. The authors report on a simplified and novel SEEG surgical technique in the extraoperative mapping of refractory focal epilepsy.
  
  
  METHODS
  The proposed technique was applied in patients with medically refractory focal epilepsy. Data regarding general demographic information, method of electrode implantation, time of implantation, number of implanted electrodes, seizure outcome after SEEG-guided resections, and complications were prospectively collected.
  
  
  RESULTS
  From March 2009 to April 2012, 122 patients underwent SEEG depth electrode implantation at the Cleveland Clinic Epilepsy Center in which the authors' technique was used. There were 65 male and 57 female patients whose mean age was 33 years (range 5-68 years). The group included 21 pediatric patients (younger than 18 years). Planning and implantations were performed in a single stage. The time for planning was, on average, 33 minutes (range 20-47 minutes), and the time for implantation was, on average, 107 minutes (range 47-150 minutes). Complications related to the SEEG technique were observed in 3 patients. The calculated risk of complications per electrode was 0.18%. The seizure-free rate after SEEG-guided resections was 62% in a mean follow-up period of 12 months.
  
  
  CONCLUSIONS
  The authors report on a safe, simplified, and less time-consuming method of SEEG depth electrode implantation, using standard and widely available surgical tools, making the technique a reasonable option for extraoperative monitoring of patients with medically intractable epilepsy in centers lacking the Talairach stereotactic armamentarium.
authors.affiliation: Epilepsy Center, Neurological Institute;
authors.forename: Jorge
authors.initials: J
authors.lastname: Gonzalez-Martinez
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Mullin
authors.forename: Sumeet
authors.initials: S
authors.lastname: Vadera
authors.forename: Juan
authors.initials: J
authors.lastname: Bulacio
authors.forename: Gwyneth
authors.initials: G
authors.lastname: Hughes
authors.forename: Stephen
authors.initials: S
authors.lastname: Jones
authors.forename: Rei
authors.initials: R
authors.lastname: Enatsu
authors.forename: Imad
authors.initials: I
authors.lastname: Najm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D004567:Electrodes, Implanted / Q000009:adverse effects / Q000592:standards*; D004569:Electroencephalography / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D013238:Stereotaxic Techniques / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D055815:Young Adult