title: Comparison of computer-assisted planning and manual planning for depth electrode implantations in epilepsy.
abstract: OBJECT The objective of this study was to evaluate the clinical utility of multitrajectory computer-assisted planning software (CAP) to plan stereoelectroencephalography (SEEG) electrode arrangements. METHODS A cohort of 18 patients underwent SEEG for evaluation of epilepsy at a single center between August 2013 and August 2014. Planning of electrodes was performed manually and stored using EpiNav software. CAP was developed as a planning tool in EpiNav. The user preselects a set of cerebral targets and optimized trajectory constraints, and then runs an automated search of potential scalp entry points and associated trajectories. Each trajectory is associated with metrics for a safety profile, derived from the minimal distance to vascular structures, and an efficacy profile, derived from the proportion of depth electrodes that are within or adjacent to gray matter. CAP was applied to the cerebral targets used in the cohort of 18 previous manually planned implantations to generate new multitrajectory implantation plans. A comparison was then undertaken for trajectory safety and efficacy. RESULTS CAP was applied to 166 electrode targets in 18 patients. There were significant improvements in both the safety profile and efficacy profile of trajectories generated by CAP compared with manual planning (p < 0.05). Three independent neurosurgeons assessed the feasibility of the trajectories generated by CAP, with 131 (78.9%) of 166 trajectories deemed suitable for implementation in clinical practice. CAP was performed in real time, with a median duration of 8 minutes for each patient, although this does not include the time taken for data preparation. CONCLUSIONS CAP is a promising tool to plan SEEG implantations. CAP provides feasible depth electrode arrangements, with quantitatively greater safety and efficacy profiles, and with a substantial reduction in duration of planning within the 3D multimodality framework.
authors.affiliation: Epilepsy Society, MRI Unit, Chalfont St Peter;|Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology;
authors.forename: Mark
authors.initials: M
authors.lastname: Nowell
authors.affiliation: Centre of Medical Imaging and Computing, University College London;
authors.forename: Rachel
authors.initials: R
authors.lastname: Sparks
authors.affiliation: Centre of Medical Imaging and Computing, University College London;
authors.forename: Gergely
authors.initials: G
authors.lastname: Zombori
authors.affiliation: Epilepsy Society, MRI Unit, Chalfont St Peter;|Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology;|Department of Neurosurgery, National Hospital for Neurology and Neurosurgery;
authors.forename: Anna
authors.initials: A
authors.lastname: Miserocchi
authors.affiliation: Epilepsy Society, MRI Unit, Chalfont St Peter;|Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology;
authors.forename: Roman
authors.initials: R
authors.lastname: Rodionov
authors.affiliation: Epilepsy Society, MRI Unit, Chalfont St Peter;|Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology;|Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
authors.forename: Beate
authors.initials: B
authors.lastname: Diehl
authors.affiliation: Epilepsy Society, MRI Unit, Chalfont St Peter;|Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology;|Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Wehner
authors.affiliation: Department of Statistical Science, University College London; and.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Baio
authors.affiliation: Department of Neurosurgery, National Hospital for Neurology and Neurosurgery;
authors.forename: Gianluca
authors.initials: G
authors.lastname: Trevisi
authors.affiliation: Department of Neurosurgery, Great Ormond Street Hospital;
authors.forename: Martin
authors.initials: M
authors.lastname: Tisdall
authors.affiliation: Centre of Medical Imaging and Computing, University College London;
authors.forename: Sebastien
authors.initials: S
authors.lastname: Ourselin
authors.affiliation: Epilepsy Society, MRI Unit, Chalfont St Peter;|Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology;|Department of Neurosurgery, National Hospital for Neurology and Neurosurgery;
authors.forename: Andrew W
authors.initials: AW
authors.lastname: McEvoy
authors.affiliation: Epilepsy Society, MRI Unit, Chalfont St Peter;|Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology;
authors.forename: John
authors.initials: J
authors.lastname: Duncan
mesh_terms: D000328:Adult; D001921:Brain / Q000601:surgery*; D000069280:Electrocorticography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects; D004827:Epilepsy / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D012306:Risk; D012984:Software; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
keywords: CAP = computer-assisted planning software; IQR = interquartile range; SEEG = stereoelectroencephalography; computer-assisted planning; epilepsy; intracranial EEG; stereoelectroencephalography