Technical note: preliminary surgical experience with a new implantable epicranial stimulation device for chronic focal cortex stimulation in drug-resistant epilepsy

Acta Neurochirurgica, vol. 166, pp. 145

Abstract

PURPOSE: This study is to report some preliminary surgical considerations and outcomes after the first implantations of a new and commercially available implantable epicranial stimulation device for focal epilepsy. METHODS: We retrospectively analyzed data from clinical notes. Outcome parameters were as follows: wound healing, surgery time, and adverse events. RESULTS: Five patients were included (17-52 y/o; 3 female). Epicranial systems were uneventfully implanted under neuronavigation guidance. Some minor adverse events occurred. Wound healing in primary intention was seen in all patients. Out of these surgeries, certain concepts were developed: Skin incisions had to be significantly larger than expected. S-shaped incisions appeared to be a good choice in typical locations behind the hairline. Preoperative discussions between neurologist and neurosurgeon are mandatory in order to allow for the optimal coverage of the epileptogenic zone with the electrode geometry. CONCLUSION: In this first small series, we were able to show safe implantation of this new epicranial stimulation device. The use of neuronavigation is strongly recommended. The procedure is simple but not trivial and ideally belongs in the hands of a neurosurgeon.

Authors 8

1. Volker Arnd Coenen corresponding

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Center for Deep Brain Stimulation, Medical Center of Freiburg University, Breisacher Straße, 64-79106, Freiburg, Germany. volker.coenen@uniklinik-freiburg.de

   Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße, 64-79106, Freiburg, Germany. volker.coenen@uniklinik-freiburg.de

   Medical Faculty of Freiburg University, Freiburg, Germany. volker.coenen@uniklinik-freiburg.de

   Center for Deep Brain Stimulation, Medical Center of Freiburg University, Breisacher Straße, 64–79106, Freiburg, Germany

   Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße, 64–79106, Freiburg, Germany

   Medical Faculty of Freiburg University, Freiburg, Germany

2. Nadja Jarc

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße, 64-79106, Freiburg, Germany

   Medical Faculty of Freiburg University, Freiburg, Germany

   Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße, 64–79106, Freiburg, Germany

3. Martin Hirsch

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Epilepsy Center, Neurocenter, Medical Center of Freiburg University, Breisacher Straße, 64-79106, Freiburg, Germany

   Medical Faculty of Freiburg University, Freiburg, Germany

   Epilepsy Center, Neurocenter, Medical Center of Freiburg University, Breisacher Straße, 64–79106, Freiburg, Germany

4. Peter Christoph Reinacher Aachen Fraunhofer Institute for Laser Technology (ILT)

   University of Freiburg · University Medical Center Freiburg · Fraunhofer Institute for Laser Technology

   Affiliation as printed

   Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße, 64-79106, Freiburg, Germany

   Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany

   Medical Faculty of Freiburg University, Freiburg, Germany

   Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße, 64–79106, Freiburg, Germany

5. Bernhard Jochen Steinhoff

   University of Freiburg · Diakonie Kork

   Affiliation as printed

   Kork Epilepsy Center, Kehl-Kork, Germany

   Medical Faculty of Freiburg University, Freiburg, Germany

6. Thomas Bast

   Diakonie Kork

   Affiliation as printed

   Kork Epilepsy Center, Kehl-Kork, Germany

7. Andreas Schulze‐Bonhage

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Epilepsy Center, Neurocenter, Medical Center of Freiburg University, Breisacher Straße, 64-79106, Freiburg, Germany

   Medical Faculty of Freiburg University, Freiburg, Germany

8. Bastian Sajonz

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße, 64-79106, Freiburg, Germany

   Medical Faculty of Freiburg University, Freiburg, Germany

   Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße, 64–79106, Freiburg, Germany