Rationale:
Subdural electrode (SDE) implantation is still an important method of diagnosing epileptogenic lesions even with the current preference for stereoelectroencephalography. In this study, we developed a new method to assess both SDE and brain surface during surgery using brain images three-dimensionally printed into permeable films and intraoperative fluoroscopy. This method can improve the spatial accuracy of SDE implantation.
Methods:
Preoperative imaging, such as magnetic resonance imaging and computed tomography, was performed and images were edited and fused to better visualize the gyrus and sulcus. We printed the images on permeable films and superimposed them on the intraoperative fluoroscopy display. After the implantation surgery, the intra-operative and postoperative coordinates of the electrodes were obtained, and the differences in the locations were calculated.
Results:
Permeable films were created for a total of three patients with intractable epilepsy. Two patients had bilateral temporal lobe epilepsy, and one had ulegyria of the frontal lobe. Electrocorticography was performed in all patients, and functional mapping of verbal memory was performed in two patients. All patients underwent focal resection surgery after recording. The differences in the electrodes between the intraoperative and postoperative images were 5.7 ± 2.1, 6.8 ± 3.3, and 9.5 ± 4.4 mm.
Conclusions:
Our new method may guide the implantation of SDEs into their planned location and minimize the extent of the surgical field.
Funding: AMED under grant number JP23wm0525006