title: Usefulness of multidetector-row computerized tomographic angiography for the surgical planning in stereoelectroencephalography.
abstract: OBJECTIVE
  Surgical planning of depth electrode implantation in stereo-electro-encephalography (SEEG) routinely uses magnetic resonance imaging (MRI) alone. Accurate visualization of arteries and veins in the vicinity of the electrode is essential to plan a safe trajectory to presumably reduce the risk of intracranial bleeding. The goal of this study was to compare multidetector row computerized tomographic angiography (MDCTA) with MRI for the visualization of vessels along each planned trajectory in patients who undergo SEEG.
  
  
  METHODS
  Ten consecutive patients who were scheduled to undergo SEEG procedure were included. T1-weighted gadolinium-chelate enhanced MR sequence, stereotactic MDCT and MDCTA were performed after fixation of Leksell's frame. For each of the 106 planned stereotactic trajectories, the number of vessels in a 4.0mm diameter circle around the trajectory from the dura mater to the target that were visible on MDCTA were compared to that of visible vessels in the same areas on MRI.
  
  
  RESULTS
  Ten vessels (10/106; 9.4%) were seen on MRI and 66 (66/106; 62.3%) on MDCTA (P<0.0001). All vessels visible on MRI were visible on MDCTA. The difference in number of visible vessels between the two techniques remained significant for the different lobes (i.e., frontal lobe, temporal lobe and parieto-occipital lobe).
  
  
  CONCLUSIONS
  MDCTA enabled visualization of more vessels than MRI based SEEG. MDCTA may help neurosurgeons better define the trajectory of the electrode and reduce the risk of intracranial bleeding.
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France. Electronic address: vianney.gilard@chu-rouen.fr.
authors.forename: V
authors.initials: V
authors.lastname: Gilard
authors.affiliation: Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France.
authors.forename: F
authors.initials: F
authors.lastname: Proust
authors.affiliation: Department of Radiology, Rouen University Hospital, Charles-Nicolle Hospital, 1, rue de Germont, Rouen, France.
authors.forename: E
authors.initials: E
authors.lastname: Gerardin
authors.affiliation: Department of Physiology, Rouen University Hospital, Charles-Nicolle Hospital, 1, rue de Germont, Rouen, France.
authors.forename: A
authors.initials: A
authors.lastname: Lebas
authors.affiliation: Department of Physiology, Rouen University Hospital, Charles-Nicolle Hospital, 1, rue de Germont, Rouen, France.
authors.forename: N
authors.initials: N
authors.lastname: Chastan
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
authors.forename: P
authors.initials: P
authors.lastname: Fréger
authors.affiliation: Department of Physiology, Rouen University Hospital, Charles-Nicolle Hospital, 1, rue de Germont, Rouen, France.
authors.forename: D
authors.initials: D
authors.lastname: Parain
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
authors.forename: S
authors.initials: S
authors.lastname: Derrey
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D000072226:Computed Tomography Angiography / Q000379:methods*; D004567:Electrodes, Implanted; D004569:Electroencephalography; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D061330:Multidetector Computed Tomography; D010347:Patient Care Planning; D019919:Prosthesis Implantation / Q000379:methods*; D025321:Surgery, Computer-Assisted; D055815:Young Adult
keywords: Epilepsy; Multidetector-row computerized tomographic angiography; Stereoelectroencephalography; Surgical planning