title: Multi-trajectories automatic planner for StereoElectroEncephaloGraphy (SEEG).
abstract: OBJECTIVE
  StereoElectroEncephaloGraphy (SEEG) is done to identify the epileptogenic zone of the brain using several multi-lead electrodes whose positions in the brain are pre-operatively defined. Intracranial hemorrhages due to disruption of blood vessels can cause major complications of this procedure ([Formula: see text]1%). In order to increase the intervention safety, we developed and tested planning tools to assist neurosurgeons in choosing the best trajectory configuration.
  
  
  METHODS
  An automated planning method was developed that maximizes the distance of the electrode from the vessels and avoids the sulci as entry points. The angle of the guiding screws is optimized to reduce positioning error. The planner was quantitatively and qualitatively compared with manually computed trajectories on 26 electrodes planned for three patients undergoing SEEG by four neurosurgeons. Quantitative comparison was performed computing for each trajectory using (a) the Euclidean distance from the closest vessel and (b) the incidence angle.
  
  
  RESULTS
  Quantitative evaluation shows that automatic planned trajectories are safer in terms of distance from the closest vessel with respect to manually planned trajectories. Qualitative evaluation performed by four neurosurgeons showed that the automatically computed trajectories would have been preferred to manually computed ones in 30% of the cases and were judged good or acceptable in about 86% of the cases. A significant reduction in time required for planning was observed with the automated system (approximately 1/10).
  
  
  CONCLUSIONS
  The automatic SEEG electrode planner satisfied the essential clinical requirements, by providing safe trajectories in an efficient timeframe.
authors.affiliation: Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy. elena.demomi@polimi.it.
authors.forename: E
authors.initials: E
authors.lastname: De Momi
authors.affiliation: Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Caborni
authors.affiliation: "Claudio Munari" Centre for Epilepsy and Parkinson Surgery Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Cardinale
authors.affiliation: "Claudio Munari" Centre for Epilepsy and Parkinson Surgery Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Casaceli
authors.affiliation: "Claudio Munari" Centre for Epilepsy and Parkinson Surgery Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Castana
authors.affiliation: "Claudio Munari" Centre for Epilepsy and Parkinson Surgery Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cossu
authors.affiliation: "Claudio Munari" Centre for Epilepsy and Parkinson Surgery Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Mai
authors.affiliation: "Claudio Munari" Centre for Epilepsy and Parkinson Surgery Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Gozzo
authors.affiliation: "Claudio Munari" Centre for Epilepsy and Parkinson Surgery Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Francione
authors.affiliation: "Claudio Munari" Centre for Epilepsy and Parkinson Surgery Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Tassi
authors.affiliation: "Claudio Munari" Centre for Epilepsy and Parkinson Surgery Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Lo Russo
authors.affiliation: Orobix Srl, Bergamo, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Antiga
authors.affiliation: Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Ferrigno
mesh_terms: D000328:Adult; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D005625:Frontal Lobe / Q000601:surgery; D006801:Humans; D020300:Intracranial Hemorrhages / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D013238:Stereotaxic Techniques; D013702:Temporal Lobe / Q000601:surgery
keywords: Computer-assisted surgery; Epilepsy; StereoElectroEncephaloGraphy
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