Stereotactic accuracy of stereoelectroencephalography procedures should be measured at both the entry and target points
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LETTER TO THE EDITOR - FUNCTIONAL NEUROSURGERY - EPILEPSY
Stereotactic accuracy of stereoelectroencephalography procedures should be measured at both the entry and target points Francesco Cardinale 1 & Michele Rizzi 1 & Piergiorgio d’Orio 1,2
&
Laura Castana 1
Received: 30 June 2020 / Accepted: 4 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Dear editor, We read with great interest the study recently published by Girgis et al. on Acta Neurochirurgica, comparing the accuracy of two systems used to implant stereoelectroencephalography (SEEG) electrodes, one frame-based and one frameless [5]. The authors report the application accuracy only at the target point (TP) of 81 intracerebral electrodes, stereotactically implanted in 23 patients. The reported accuracy is 11.0 mm and 7.1 mm at amygdala target with frameless or frame-based technique, respectively. Similarly, it is 12.4 mm and 8.5 mm at hippocampal target, with frameless or frame-based technique, respectively. This accuracy is largely the worst ever reported for SEEG procedures [7]. SEEG is well known to be safe and efficient, given that every effort is done in order to guarantee the best stereotactic accuracy [1, 6, 7]. In 2013, our group published a series of 1050 SEEG electrodes implanted with Neuromate robotic assistant in framebased conditions, reporting median errors (with interquartile range [IQR]) of 0.78 (0.49–1.08) and 1.77 (1.25–2.51) mm at the entry point (EP) and TP, respectively [2]. More recently, we published a further series of eight SEEG procedures (127 electrodes) with even better results obtained with Neuromate robotic assistant and Neurolocate, a new frameless registration This article is part of the Topical Collection on Functional Neurosurgery - Epilepsy * Piergiorgio d’Orio [email protected] 1
“Claudio Munari” Center for Epilepsy Surgery, ASST GOM Niguarda Hospital, Piazza dell’Ospedale Maggiore 3, 20162 Milano, Italy
2
Institute of Neuroscience, National Research Council, Parma, Italy
tool [3]. Median errors (and IQR) were 0.59 (0.25–0.88) and 1.49 (1.06–2.04) mm at the EP and TP, respectively. Surprisingly, Girgis et al. limited their discussion to the comparison between their frameless and frame-based techniques, but they did not discuss at all the reasons of their so limited accuracy. We have another concern about the lack of reporting the stereotactic errors at the EP. Since most bleedings in SEEG implantations originate from superficial vessels, stereotactic accuracy at the cortical entry point should be reported every time. In fact, it is much more important than the TP localization error for the safety profile. Thanks to our high accuracy, we were recently able to publish the largest SEEG series with an optimal safety profile [4]. Reporting EP errors is important also because SEEG targets are all along the trajectory sampled by multi-lead electrodes, differently from classical depth electrodes that are aimed at sampling only deep targets. Finally, we would also highlight t
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