Comparison of Computer-Assisted Planning and Manual Planning for Depth Electrode Implantations in Epilepsy

Object: To evaluate the clinical utility of multi-trajectory computer-assisted planning (CAP) software to plan stereoEEG (SEEG) electrode arrangements in a cohort of 18 patients. Methods: 18 patients underwent SEEG for evaluation of epilepsy at a single centre between August 2013 and August 2014. Planning of electrodes was performed manually and stored using EpiNavTM software. CAP was developed as a planning tool in EpiNavTM. The user preselects a set of cerebral targets and optimised trajectory constraints, and then runs an automated search of potential scalp entry points and associated trajectories. Each trajectory carries metrics for safety profile, derived from the minimal distance to vascular structures, and efficacy profile, derived from the proportion of depth electrodes that are within or adjacent to grey matter. CAP was applied to the cerebral targets used in the cohort of 18 previous manually planned implantations to generate new multi-trajectory implantation plans. A comparison was then undertaken for trajectory safety and efficacy. Results: CAP was applied to 166 electrode targets in 18 patients. There were significant improvements in both safety profile and efficacy profile of trajectories generated by CAP compared with manual planning (p