Clinical accuracy of customized stereotactic fixtures for Stereo-EEG.

Objectives: The aim of this study was to evaluate the clinical accuracy of a new generation of custom stereotactic fixtures for placement of depth electrodes in stereo-EEG presurgical evaluation of patients with drug-resistant epilepsy. Methods: A newly designed custom stereotactic fixture based on the StarFix technology (FHC Inc, Bowdoin, ME) has been used for anchorless implantation of 101 depth electrodes (Integra, Plainsboro, NJ) in 13 patients undergoing presurgical evaluation for drug resistant epilepsy. The stereotactic fixture (a) incorporates tool guides, anchoring and structural elements whose location and geometry are calculated and optimized using algorithms implemented in Matlab (Mathworks, Natick, MA). DEETO (Arnulfo et al., 2015) software package was used to automatically detect the electrodes' contacts on post-implantation CT (b), therefore eliminating any subjectivity in calculating the targeting errors. Results: As a result of using custom geometry of the stereotactic platform, calculated through algorithms we have developed, the new design is optimized for each patient and streamlines the surgical procedures. The most important result characterizing platform's accuracy is the value of 1.75 mm for the mean lateral target localization error (c). Conclusions: Personalized stereotactic fixtures are a safe and accurate alternative to using robotic arm for the implantation of depth electrodes in patients undergoing presurgical evaluation for drug-resistant epilepsy. [ABSTRACT FROM AUTHOR]