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Congreso
XXI Congreso Nacional de la Sociedad Española de Neurocirugía
Barcelona, 17-19 Mayo 2017
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C0313 - O-ARM®+VERTEK® ASSISTED ELECTRODE PLACEMENT FOR STEREO-ELECTRO-ENCEFALOGRAPHY IN THE “SMART OR”

P. Roldán Ramos, S. García García, L.A. Reyes Figueroa, F. Gil López, A. Donaire Pedraza, M. Carreño Martínez and J. Rumiá Arboix

Hospital Clínic de Barcelona, Barcelona, Spain.

Objectives: Advanced intraoperative imaging modalities are integrating in the modern neurosurgical operative rooms. The authors present the results of a surgical technique which allows electrode placement (EP) for stereo-electro-encephalography (SEEG) in drug resistant epilepsy (DRE) with the Vertek® passive arm, guided by MR navigation, and verified by intraoperative CT(iCT) O-Arm® scanner.

Methods: Candidates for SEEG are selected by multidisciplinary epilepsy team based on comprehensive studies (PET, SPECT, VEEG, MRI). Electrode set-up planning is done in S7-PlanningStation® on preoperative findings. Patients are operated under general anaesthesia with head fixed in Doros® radiotransparent head-fixation device. A stereotactic iCT scan is launched and automatic fusion is done with preoperative MR. EP is done with the Vertek® passive arm. Control iCT scan is launched and fused to verify correct EP and rule out gross complications. Mean tip deviation is calculated; surgical time and complications are also registered. A postoperative stereotactic CT is done to validate the procedure.

Results: 20 patients were operated using this technique. A total of 159 electrodes have been implanted (mean EP per patient was 8 [3-12]). Mean tip deviation was 1,57 mm (0,76-2,3 mm). Surgical time averaged 4.5 hours with a mean electrode placement of 20 minutes/electrode (13-40 min), which shortenedwith experience. Mean monitoring days were 9 (7-12), and discharged on average at day 10 (8-15). One patient had an asymptomatic intraparenchymal haematoma, another developed deep vein thrombosis with pulmonary thromboembolism, which required cava filter and anticoagulation. Fifteen patients (75%) revealed a focal onset; 12 patients (60%) underwent resection, 4 patients (20%) radiofrequency thermal ablation, and 4 were not operated due to focal onset in eloquent area or multifocality.

Conclusions: The described O-Arm+Vertek® EP technique is safe, accurate and efficient for SEEG in DRE epilepsy invasive study.

Idiomas
Neurocirugía

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