A novel method for implementation of frameless StereoEEG in epilepsy surgery
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Updated: Apr 25, 2026
Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note
Published on: June 13, 2016
Mark Nowell1, Roman Rodionov, Beate Diehl
1*Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom; ‡Epilepsy Society, MRI Unit, Chalfont St. Peter, United Kingdom; §Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom; ¶Centre of Medical Imaging and Computing, UCL, London, United Kingdom.
Background:
Stereoelectroencephalography (SEEG) is an invasive diagnostic procedure in epilepsy surgery that is usually implemented with frame-based methods.
Objective:
To describe a new technique of frameless SEEG and report a prospective case series at a single center.
Methods:
Image integration and planning of electrode trajectories were performed preoperatively on specialized software and exported to a Medtronic S7 StealthStation. Trajectories were implemented by frameless stereotaxy using percutaneous drilling and bolt insertion.
Results:
Twenty-two patients went this technique, with the insertion of 187 intracerebral electrodes. Of 187 electrodes, 175 accurately reached their neurophysiological target, as measured by postoperative computed tomography reconstruction and multimodal image integration with preoperative magnetic resonance imaging. Four electrodes failed to hit their target due to extradural deflection, and 3 were subsequently resited satisfactorily. Eight electrodes were off target by a mean of 3.6 mm (range, 0.9-6.8 mm) due to a combination of errors in bolt trajectory implementation and bending of the electrode. There was 1 postoperative hemorrhage that was clinically asymptomatic and no postoperative infections. Sixteen patients were offered definitive cortical resections, and 6 patients were excluded from resective surgery.
Conclusion:
Frameless SEEG is a novel and safe method for implementing SEEG and is easily translated into clinical practice.
