title: Combining stereo-electroencephalography and subdural electrodes in the diagnosis and treatment of medically intractable epilepsy.
abstract: Stereo-electroencephalography (SEEG) has advantages for exploring deeper epileptic foci. Nevertheless, SEEG can only sample isolated cortical areas and its spatial limitation, with the inability to record contiguous cortical regions, may cause difficulties in interpretation. In light of these limitations, the authors describe the hybrid technique of SEEG and subdural strip electrode placement. The hybrid technique was used for a presurgical evaluation in four patients with intractable epilepsy. Initially, the depth electrodes were inserted with a robotic stereotactic system. Thereafter, a skin incision and a small craniectomy were performed at the entry point of the strip electrode trajectory. The dura was opened and, under live fluoroscopic guidance, strip electrodes were slid into the subdural space. In these patients, the additional subdural strip electrodes provided (1) information regarding the precise description of seizure spread in the cortical surface adjacent to the subdural space, (2) identification of epileptogenic zones located near the crown, (3) more precise definition of functional cortex and (4) a better delineation of the interface between epileptogenic zones and functional cortex. This hybrid technique provides additional data compared to either technique alone, offering superior understanding of the dynamics of the epileptic activity and its interaction with functional cortical areas.
authors.affiliation: Epilepsy Center, Desk S60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Rei
authors.initials: R
authors.lastname: Enatsu
authors.affiliation: Epilepsy Center, Desk S60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Bulacio
authors.affiliation: Epilepsy Center, Desk S60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Imad
authors.initials: I
authors.lastname: Najm
authors.affiliation: Epilepsy Center, Desk S60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Wyllie
authors.affiliation: Epilepsy Center, Desk S60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Norman K
authors.initials: NK
authors.lastname: So
authors.affiliation: Epilepsy Center, Desk S60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Dileep R
authors.initials: DR
authors.lastname: Nair
authors.affiliation: Epilepsy Center, Desk S60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Foldvary-Schaefer
authors.affiliation: Epilepsy Center, Desk S60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: William
authors.initials: W
authors.lastname: Bingaman
authors.affiliation: Epilepsy Center, Desk S60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: gonzalj1@ccf.org.
authors.forename: Jorge
authors.initials: J
authors.lastname: Gonzalez-Martinez
mesh_terms: D000328:Adult; D001921:Brain / Q000503:physiopathology; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013238:Stereotaxic Techniques; D013355:Subdural Space; D055815:Young Adult
keywords: Epilepsy; Invasive monitoring; Robotics; Stereotactic EEG; Strip electrode