Vascular imaging for Stereoelectroencephalography: A safety and planning study

Area of Science:

• Neurosurgery
• Medical Imaging
• Epileptology

Background:

• Stereoelectroencephalography (SEEG) requires precise electrode placement to localize the epileptogenic zone in refractory epilepsy.
• Preoperative imaging (MRI, DSA, CT) aims to prevent intracranial hemorrhage (ICH) by identifying electrode-vessel conflicts (EVCs).
• Digital Subtraction Angiography (DSA) offers high resolution but carries risks, prompting exploration of alternative methods like Intravenous Cone Beam Computed Tomography (CBCT A/V).

Purpose of the Study:

• To validate the safety and efficacy of CBCT A/V Brain for SEEG planning.
• To compare CBCT A/V's ability to detect EVCs against traditional imaging modalities.
• To investigate the relationship between conflicting vessel caliber and ICH incidence during SEEG.

Main Methods:

• A retrospective study of 20 patients undergoing SEEG with preoperative CBCT A/V and MRI Brain.
• Analysis of 273 electrode implantations, recording incidence and grade of symptomatic and asymptomatic ICH.
• Quantification of EVCs and conflicting vessel diameters identified by both CBCT A/V and MRI.

Main Results:

• Four ICH events occurred (2 symptomatic, 2 asymptomatic) across 273 electrodes.
• CBCT A/V identified significantly more EVCs (20) than MRI (6) (P < 0.0001).
• Two symptomatic ICHs were associated with EVCs (mean diameter 1.5 mm) detected by CBCT A/V but not MRI.

Conclusions:

• CBCT A/V Brain demonstrates an acceptable safety profile for SEEG planning.
• CBCT A/V significantly outperforms MRI in detecting EVCs, including those associated with ICH.
• Conflicting vessels < 1.2 mm caliber on CBCT A/V did not correlate with ICH in this SEEG series.