Electrical Source Imaging (ESI) Guidance of Depth Electrode Placement
摘要
Invasive EEG examinations using subdural, depth, and/or stereo-EEG electrodes can be the key to successful epilepsy surgery in patients with drug-resistant focal epilepsy (DRFE) if a sound surgical strategy cannot be developed based on noninvasive methods alone. Also, EEG-based individual tailoring of surgical interventions and therapeutic thermocoagulation is possible with depth electrodes. Although depth electrodes provide artifact-free EEG with very high temporal resolution, they are “myopic,” as they may not capture interictal or ictal activity generated at some distance from the electrode contacts. So far, this sampling error can only be reduced by placing a rather high number of depth electrode contacts in the volumes of interest. Electrical source imaging (ESI) can help to define target points for depth electrodes and reduce implantation complexity. However, its spatial accuracy has not yet been proven to be sufficient for minimally invasive epilepsy surgery. This chapter presents a concept that compensates for ESI inherent residual localization errors by applying individually determined or interindividual region-specific inverted error vectors (iEV) that are offset against the calculated ESI dipoles. According to initial data, iEV application reduces the mean ESI error in both deep and superficial brain structures to a “stereotactic neurosurgical dimension,” which should encourage further studies.