Table 5.
Summary of published literature of clinical studies utilizing CAP for SEEG
| Publication | CAP platform | MINORS | Type | Number of patients (electrodes) | Parameters optimized | Comments |
|---|---|---|---|---|---|---|
| De Momi et al. (2013) | 3D Slicer | 16/24 | Retrospective | 15 (199) |
Vessel distance Skull drilling angle Sulci |
Single electrode planning Entry and target points manually selected by surgeon and 4.38 mm and 4.27 mm search radius applied respectively No external validation |
| Zombori (et al 2014) | EpiNav | 12/24 | Retrospective | 6 (30) |
Vessel distance Skull drilling angle Electrode length Risk score |
Single electrode planning Overall electrode risk score, length, and drilling angle were improved with CAP |
| De Momi et al. (2014) | 3D Slicer | 16/24 | Retrospective | 3 (24) |
Vessel distance Skull drilling angle Adherence to planned entry and target structure Cortex curvature value |
Multielectrode planning 1.6 mm safety margin from vasculature within 2.5 cm of skull entry point and 1 mm safety margin thereafter Maximum drilling angle 40° Minimum distance from vessel was significantly improved with multielectrode planning No external validation |
| Zelmann et al. (2014) | MINC toolkit | 14/24 | Retrospective | 6 (27) |
Vessel distance Sulci Ventricles Gray matter sampling Target volume sampling |
Multielectrode planning Only amygdala and hippocampus targeted Automated trajectories improved target volume sampling, distance from vasculature and gray matter contact 25/27 trajectories were rated feasible |
| Zelmann et al. (2015) | MINC toolkit | 14/24 | Retrospective | 20 (116) |
Risk score ROI recording volume Gray matter sampling Skull drilling angle |
Multielectrode planning Only 3 electrodes (amygdala, anterior hippocampus, and posterior hippocampus) planned with target structures defined as ROIs. Single neurosurgeon did feasibility assessment on all patients. A second neurosurgeon scored 12 patients. No external validation Automated trajectories were statistically safer overall and rated more feasible than those that were manually planned. Insertion angle was higher with automated trajectories |
| Nowell et al. (2016) | EpiNav | 16/24 | Retrospective | 18 (166) |
Electrode length Skull drilling angle Risk score Vessel distance Gray matter sampling Sulci |
Multielectrode planning 3 mm safety margin from vasculature along entire length of trajectory with risk profile graphic Surgeon manually selects target point Able to generate 98.2% of the required trajectories External blinded evaluation revealed 79% were feasible for implantation without further adjustment |
| Scorza et al. (2017) | 3D Slicer | 14/24 | Retrospective | 20 (253) |
Vessel distance Sulcal avoidance Skull drilling angle Electrode conflicts |
Multielectrode planning 4 mm safety margin from vasculature within 1 cm of skull entry point and 1 mm safety margin thereafter Entry and target points manually selected by surgeon and 7 mm and 3 mm search radius applied respectively Improvement in optimization parameters in 98% of electrodes. No feasibility ratings of trajectories or external validation undertaken. |
| Sparks et al. (2017)a | EpiNav | 16/24 | Retrospective | 18 (165) |
Electrode length Skull drilling angle Risk score Vessel distance Gray matter sampling Sulci |
Multielectrode planning 3 mm safety margin from vasculature along entire length of trajectory with risk profile graphic Surgeon manually selects target point Entry structure risk map generation Improvement in risk, gray matter sampling, intracerebral length, and drilling angle with CAP Skull template to remove infeasible entry points |
| Sparks et al. (2017)b | EpiNav | 16/24 | Retrospective | 20 (190) |
Electrode length Skull drilling angle Risk score Vessel distance Gray matter sampling Sulci |
Multielectrode planning 3 mm safety margin from vasculature along entire length of trajectory with risk profile graphic Entry and target regions defined as anatomic ROIs allowing algorithm to define optimal entry and target points Entry and target structure risk map generation Iterative relaxation of hard constraints if suitable trajectories cannot be found External blinded feasibility ratings were 97% for manual and 90% for CAP generated trajectories |
| Vakharia et al. (2017) | EpiNav | 20/24 | Retrospective | 13 (116) |
Electrode length Skull drilling angle Risk score Vessel distance Gray matter sampling Sulci |
Multielectrode planning 3 mm safety margin from vasculature along entire length of trajectory with risk profile graphic Entry and target regions defined as anatomic ROIs allowing algorithm to define optimal entry and target points External review of manual and CAP trajectories in blinded fashion revealed no difference in feasibility Improvement in risk, gray matter sampling, intracerebral length and drilling angle with CAP |
| Vakharia et al. (2018)* | EpiNav | 24/24 | Prospective | 13 (125) |
Electrode length Skull drilling angle Risk score Vessel distance Gray matter sampling Sulci |
Multielectrode planning First prospective CAP study in which CAP trajectories were implemented with no adverse events Significant improvement in risk score |
*Current study