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Implantation of subdural electrodes on the brain surface is still widely performed as one of the “gold standard methods” for the presurgical evaluation of epilepsy. Stereotactic insertion of depth electrodes to the brain can be added to detect brain activities in deep-seated lesions to which surface electrodes are insensitive. This study tried to clarify the efficacy and limitations of combined implantation of subdural and depth electrodes in intractable epilepsy patients. Fifty-three patients with drug-resistant epilepsy underwent combined implantation of subdural and depth electrodes for long-term intracranial electroencephalography (iEEG) before epilepsy surgery. The detectability of early ictal iEEG change (EIIC) were compared between the subdural and depth electrodes. We also examined clinical factors including resection of MRI lesion and EIIC with seizure freedom. Detectability of EIIC showed no significant difference between subdural and depth electrodes. However, the additional depth electrode was useful for detecting EIIC from apparently deep locations, such as the insula and mesial temporal structures, but not in detecting EIIC in patients with ulegyria (glial scar). Total removal of MRI lesion was associated with seizure freedom. Depth electrodes should be carefully used after consideration of the suspected etiology to avoid injudicious usage.

Interictal epileptiform discharges (IEDs) are a widely used biomarker in patients with epilepsy but lack specificity. It has been proposed that there are truly epileptogenic and less pathological or even protective IEDs. Recent studies suggest that highly pathological IEDs are characterized by high-frequency oscillations (HFOs). Here, we aimed to dissect these ‘HFO-IEDs’ at the single-neuron level, hypothesizing that the underlying mechanisms are distinct from ‘non-HFO-IEDs’. Analysing hybrid depth electrode recordings from patients with temporal lobe epilepsy, we found that single-unit firing rates were higher in HFO- than in non-HFO-IEDs. HFO-IEDs were characterized by a pronounced pre-peak increase in firing, which coincided with the preferential occurrence of HFOs, whereas in non-HFO-IEDs, there was only a mild pre-peak increase followed by a post-peak suppression. Comparing each unit’s firing during HFO-IEDs to its baseline activity, we found many neurons with a significant increase during the HFO component or ascending part, but almost none with a decrease. No such imbalance was observed during non-HFO-IEDs. Finally, comparing each unit’s firing directly between HFO- and non-HFO-IEDs, we found that most cells had higher rates during HFO-IEDs and, moreover, identified a distinct subset of neurons with a significant preference for this IED subtype. In summary, our study reveals that HFO- and non-HFO-IEDs have different single-unit correlates. In HFO-IEDs, many neurons are moderately activated, and some participate selectively, suggesting that both types of increased firing contribute to highly pathological IEDs.

Understanding the neuronal basis of epileptic activity is a major challenge in neurology. Cellular integration into larger scale networks is all the more challenging. In the local field potential, interictal epileptic discharges can be associated with fast ripples (200–600 Hz), which are a promising marker of the epileptogenic zone. Yet, how neuronal populations in the epileptogenic zone and in healthy tissue are affected by fast ripples remain unclear. Here, we used a novel ‘hybrid’ macro–micro depth electrode in nine drug-resistant epileptic patients, combining classic depth recording of local field potentials (macro-contacts) and two or three tetrodes (four micro-wires bundled together) enabling up to 15 neurons in local circuits to be simultaneously recorded. We characterized neuronal responses (190 single units) with the timing of fast ripples (2233 fast ripples) on the same hybrid and other electrodes that target other brain regions. Micro-wire recordings reveal signals that are not visible on macro-contacts. While fast ripples detected on the closest macro-contact to the tetrodes were always associated with fast ripples on the tetrodes, 82% of fast ripples detected on tetrodes were associated with detectable fast ripples on the nearest macro-contact. Moreover, neuronal recordings were taken in and outside the epileptogenic zone of implanted epileptic subjects and they revealed an interlay of excitation and inhibition across anatomical scales. While fast ripples were associated with increased neuronal activity in very local circuits only, they were followed by inhibition in large-scale networks (beyond the epileptogenic zone, even in healthy cortex). Neuronal responses to fast ripples were homogeneous in local networks but differed across brain areas. Similarly, post-fast ripple inhibition varied across recording locations and subjects and was shorter than typical inter-fast ripple intervals, suggesting that this inhibition is a fundamental refractory process for the networks. These findings demonstrate that fast ripples engage local and global networks, including healthy tissue, and point to network features that pave the way for new diagnostic and therapeutic strategies. They also reveal how even localized pathological brain dynamics can affect a broad range of cognitive functions.

Objective The number of patients requiring depth electrode implantation for invasive video EEG diagnostics increases in most epilepsy centres. Here we report on our institutional experience with frameless robot-assisted stereotactic placement of intracerebral depth electrodes using the Neuromate® stereotactic robot-system. Methods We identified all patients who had undergone robot-assisted stereotactic placement of intracerebral depth electrodes for invasive extra-operative epilepsy monitoring between September 2013 and March 2020. We studied technical (placement) and diagnostic accuracy of the robot-assisted procedure, associated surgical complications and procedural time requirements. Results We evaluated a total of 464 depth electrodes implanted in 74 patients (mean 6 per patient, range 1–12). There were 27 children and 47 adults (age range: 3.6–64.6 yrs.). The mean entry and target point errors were 1.82±1.15 and 1.98±1.05 mm. Target and entry point errors were significantly higher in paediatric vs. adult patients and for electrodes targeting the temporo-mesial region. There were no clinically relevant haemorrhages and no infectious complications. Mean time for the placement of one electrode was 37±14 min and surgery time per electrode decreased with the number of electrodes placed. 55 patients (74.3%) underwent definitive surgical treatment. 36/51 (70.1%) patients followed for >12 months or until seizure recurrence became seizure-free (ILAE I). Conclusion Frameless robot-guided stereotactic placement of depth electrodes with the Neuromate® stereotactic robot-system is safe and feasible even in very young children, with good in vivo accuracy and high diagnostic precision. The surgical workflow is time-efficient and further improves with increasing numbers of implanted electrodes.

The insula is well established as an epileptogenic area.(1) Insular epilepsy surgery demands precise anatomic knowledge(2-4) and tailored removal of the epileptic zone with careful neuromonitoring.(5) We present an operative video illustrating an intracranial electroencephalogram (EEG) depth electrode guided anterior insulectomy. We report a 17-yr-old right-handed woman with a 4-yr history of medically refractory epilepsy. The patient reported daily nocturnal ictal vocalization preceded by an indescribable feeling. Preoperative evaluation was suggestive of a right frontal-temporal onset, but the noninvasive results were discordant. She underwent a combined intracranial EEG study with a frontal-parietal grid, with strips and depth electrodes covering the entire right hemisphere. Epileptiform activity was observed in contact 6 of the anterior insula electrode. The patient consented to the procedure and to the publication of her images. A right anterior insulectomy was performed. First, a portion of the frontal operculum was resected and neuronavigation was used for the initial insula localization. However, due to unreliable neuronavigation (ie, brain shift), the medial and anterior borders of the insular resection were guided by the depth electrode reference. The patient was discharged 3 d after surgery with no neurological deficits and remains seizure free. We demonstrate that depth electrode guided insular surgery is a safe and precise technique, leading to an optimal outcome.

Objective To determine the optimal depth electrode montages for the assessment of effective connectivity based on single-pulse electrical stimulation (SPES). To determine the effect of SPES locations on the extent of resulting neuronal propagations. Methods We studied 14 epilepsy patients who underwent invasive monitoring with depth electrodes and measurement of cortico-cortical evoked potentials (CCEPs) and cortico-cortical spectral responses (CCSRs). We determined the effects of electrode montage and stimulus sites on the CCEP/CCSR amplitudes. Results Bipolar and Laplacian montages effectively reduced the degree of SPES-related signal deflections at extra-cortical levels, including outside the brain, while maintaining those at the cortical level. SPES of structures more proximal to the deep white matter, compared to the cortical surface, elicited greater CCEPs and CCSRs. Conclusions On depth electrode recording, bipolar and Laplacian montages are suitable for measurement of near-field CCEPs and CCSRs. SPES of the white matter axons may induce neuronal propagations to extensive regions of the cerebral cortex. Significance This study helps to establish the practical guidelines on the diagnostic use of CCEPs/CCSRs.

Stereotactic planning plays a pivotal role in various neurosurgical procedures including deep brain stimulation (DBS), depth electrode placement, and stereoencephalography (sEEG) for intracranial monitoring in patients with epilepsy, responsive neurostimulation (RNS), laser interstitial thermal therapy (LITT), and biopsies. Presurgical planning is essential to success. This requires a thorough knowledge of clinical presentation, medical history, risk factors, results of preoperative studies, and possible benefits and hazards of surgery. Integration of this knowledge with an understanding of key principles of trajectory planning allows for deep structures of the brain to be approached safely.

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BACKGROUND It has been increasingly recognized that the insular cortex plays an important role in frontotemporal-parietal epilepsy in children. The insula, however, cannot be properly interrogated with conventional subdural grids, and its anatomy makes it difficult to implicate the insula with semiology or noninvasive modalities. Frame-based, stereotactic placement of insular depth electrodes for direct extraoperative monitoring is a relatively low-risk maneuver that allows for conclusive interrogation of this region, and, in select cases, can easily be replaced with a laser applicator for minimally invasive treatment via thermoablation. OBJECTIVE To describe the largest reported series of pediatric patients with refractory epilepsy undergoing insular depth electrode placement. METHODS We used current procedural terminology billing records to identify cases of depth electrode insertion performed at our institution. Clinical information from patients undergoing invasive insular sampling was then retrospectively collected. RESULTS Seventy-four insular depth electrodes were placed in 49 patients for extraoperative, inpatient monitoring. The decision to place insular depth electrodes was determined by a multidisciplinary epilepsy team. In 65.3% of cases, direct invasive sampling implicated the insula in seizure onset and prompted either thermoablation or surgical resection of some portion of the insula. There were no serious adverse effects or complications associated with the placement of insular depth electrodes. CONCLUSION Given the low morbidity of insular depth electrode insertion and the high proportion of patients who exhibited insular involvement, it is worth considering whether insular depth electrodes should be part of the standard presurgical evaluation in children with treatment-refractory frontotemporal-parietal epilepsy.

Background For intracranial electroencephalographic monitoring, stereotactically implanted depth electrodes are increasingly used at epilepsy centers around the world. Objective To identify pearls and pitfalls from our experience with stereotactic Leksell (Elekta AB, Stockhom, Sweden) frame-based depth electrode implantation. Methods An intraoperative video of the implantation technique was recorded. Results A detailed description and a video on how to implant depth electrodes using the stereotactic Leksell frame is provided. Conclusion Neurosurgeons implanting depth electrodes for intracranial electroencephalographic monitoring might find the technical nuances and caveats described in this technical note useful for their practice.

International audience; Background: Recordings with tetrodes have proven to be more effective in isolating single neuron spiking activity than with single microwires. However, tetrodes have never been used in humans. We report on the characteristics, safety, compatibility with clinical intracranial recordings in epileptic patients, and performance, of a new type of hybrid electrode equipped with tetrodes. New Method: 240 standard clinical macroelectrodes and 102 hybrid electrodes were implanted in 28 patients. Hybrids (diameter 800 µm) are made of 6 or 9 macro-contacts and 2 or 3 tetrodes (diameter 70-80 µm). Results: No clinical complication or adverse event was associated with the hybrids. Impedance and noise of recordings were stable over time. The design enabled multiscale spatial analyses that revealed physiopathological events which were sometimes specific to one tetrode, but could not be recorded on the macro-contacts. After spike sorting, the single-unit yield was similar to other hybrid electrodes and was sometimes as high as > 10 neurons per tetrode. Comparison with Existing Method(s): This new hybrid electrode has a smaller diameter than other available hybrid electrodes. It provides novel spatial information due to the configuration of the tetrodes. The single-unit yield appears promising. Conclusions: This new hybrid electrode is safe, easy to use, and works satisfactorily for conducting multi-scale seizure and physiological analyses.

Background: To control brain tumor-related epilepsy (BTRE), both epileptological and neuro-oncological approaches are required. We hypothesized that using depth electrodes (DEs) as fence post catheters, we could detect the area of epileptic seizure onset and achieve both brain tumor removal and epileptic seizure control. Methods: Between August 2009 and April 2018, we performed brain tumor removal for 27 patients with BTRE. Patients who underwent lesionectomy without DEs were classified into Group 1 (13 patients) and patients who underwent the fence post DE technique were classified into Group 2 (14 patients). Results: The patients were 15 women and 12 men (mean age, 28.1 years; median age 21 years; range, 5–68 years). The brain tumor was resected to a greater extent in Group 2 than Group 1 (P < 0.001). Shallower contacts showed more epileptogenicity than deeper contacts (P < 0.001). Group 2 showed better epilepsy surgical outcomes than Group 1 (P = 0.041). Conclusion: Using DEs as fence post catheters, we detected the area of epileptic seizure onset and controlled epileptic seizures. Simultaneously, we removed the brain tumor to a greater extent with fence post DEs than without.

Background: Subcortical epilepsies associated with developmental tumors in the cerebellum are rarely experienced. As supportive evidence of the intrinsic epileptogenicity of cerebellar tumors, previous electroencephalogram (EEG) studies with intratumoral depth electrodes demonstrated epileptiform or ictal discharges. Recent studies have demonstrated that high frequency oscillations (HFOs) can be regarded as a new biomarker of epileptogenesis and ictogenesis; however, there are few evidence about HFOs in cases of epilepsy associated with cerebellar tumors. Case Description: A 6-month-old Japanese male infant presented to our hospital with drug resistant epilepsy. We underwent subtotal resection of a cerebellar gangliocytoma and obtained good seizure outcomes. Intraoperative EEG in the tumor depicted HFOs in the form of ripples, riding on periodic discharges. Conclusion: Our findings provide further supportive evidence for the intrinsic epileptogenicity of cerebellar tumors.

Background Classically, transoccipital hippocampal depth electrode implantation requires a stereotactic headframe and arc and the patient to be placed in a seated or prone position, which can be cumbersome to position and uncomfortable for the surgeon. Robotic intracranial devices are increasingly being utilized for stereotactic procedures such as stereolectroencephalography (SEEG) but commonly require patients be placed in head-neutral position to perform facial registration. Objective Here we describe a novel robotic implantation technique where a stereotactic intracranial robot is used to place bilateral hippocampal depth electrodes in the lateral position. Methods Four patients underwent SEEG depth electrode placement, which included placement of bilateral hippocampal depth electrodes. Each patient was positioned in the lateral position and registered to the robot with laser facial registration. Trajectories were planned with the robotic navigation software, which then identified the appropriate entry points and trajectories needed to reach the targets. After electrode implantation, target localization was confirmed using computed tomography (CT). Results Electrodes targeting the amygdalohippocampal complex were accurate and there were no complications in this group. An average of seven electrodes were placed per patient. Ictal onset was localized for each patient. All patients subsequently underwent temporal lobectomy and 75% have been seizure free since surgery. Conclusions We have developed the Robot-Assisted Lateral Transoccipital Approach (RALTA), which is an advantageous technique for placing bilateral amygdalohippocampal depth electrodes using robotic guidance. Benefits of this technique include fewer electrodes required per patient and ease of positioning compared with seated or prone positioning.

V1 is fundamentally grouped into columns that descend from layers II-III to V-VI. Neurons inherent to visual cortex are capable of adapting to changes in the incoming stimuli that drive the cortical plasticity. A principle feature called orientation selectivity can be altered by the presentation of non-optimal stimulus called 'adapter'. When triggered, LGN cells impinge upon layer IV and further relay the information to deeper layers via layers II-III. Using different adaptation protocols, neuronal plasticity can be investigated. Superficial neurons in area V1 are well acknowledged to exhibit attraction and repulsion by shifting their tuning peaks when challenged by a non-optimal stimulus called 'adapter'. Layers V-VI neurons in spite of partnering layers II-III neurons in cortical computation have not been explored simultaneously toward adaptation. We believe that adaptation not only affects cells specific to a layer but modifies the entire column. In this study, through simultaneous multiunit recordings in anesthetized cats using a multichannel depth electrode, we show for the first time how layers V-VI neurons (1000-1200 μm) along with layers II-III neurons (300-500 μm) exhibit plasticity in response to adaptation. Our results demonstrate that superficial and deeper layer neurons react synonymously toward adapter by exhibiting similar behavioral properties. The neurons displayed similar amplitude of shift and maintained equivalent sharpness of Gaussian tuning peaks before and the following adaptation. It appears that a similar mechanism, belonging to all layers, is responsible for the analog outcome of the neurons' experience with adapter.

To what extent electrocorticography (ECoG) and electroencephalography (scalp EEG) differ in their capability to locate sources of deep brain activity is far from evident. Compared to EEG, the spatial resolution and signal-to-noise ratio of ECoG is superior but its spatial coverage is more restricted, as is arguably the volume of tissue activity effectively measured from. Moreover, scalp EEG studies are providing evidence of locating activity from deep sources such as the hippocampus using high-density setups during quiet wakefulness. To address this question, we recorded a multimodal dataset from 4 patients with refractory epilepsy during quiet wakefulness. This data comprises simultaneous scalp, subdural and depth EEG electrode recordings. The latter was located in the hippocampus or insula and provided us with our "ground truth" for source localization of deep activity. We applied independent component analysis (ICA) for the purpose of separating the independent sources in theta, alpha and beta frequency band activity. In all patients subdural- and scalp EEG components were observed which had a significant zero-lag correlation with one or more contacts of the depth electrodes. Subsequent dipole modeling of the correlating components revealed dipole locations that were significantly closer to the depth electrodes compared to the dipole location of non-correlating components. These findings support the idea that components found in both recording modalities originate from neural activity in close proximity to the depth electrodes. Sources localized with subdural electrodes were ~70% closer to the depth electrode than sources localized with EEG with an absolute improvement of around ~2cm. In our opinion, this is not a considerable improvement in source localization accuracy given that, for clinical purposes, ECoG electrodes were implanted in close proximity to the depth electrodes. Furthermore, the ECoG grid attenuates the scalp EEG, due to the electrically isolating silastic sheets in which the ECoG electrodes are embedded. Our results on dipole modeling show that the deep source localization accuracy of scalp EEG is comparable to that of ECoG. SIGNIFICANCE STATEMENT: Deep and subcortical regions play an important role in brain function. However, as joint recordings at multiple spatial scales to study brain function in humans are still scarce, it is still unresolved to what extent ECoG and EEG differ in their capability to locate sources of deep brain activity. To the best of our knowledge, this is the first study presenting a dataset of simultaneously recorded EEG, ECoG and depth electrodes in the hippocampus or insula, with a focus on non-epileptiform activity (quiet wakefulness). Furthermore, we are the first study to provide experimental findings on the comparison of source localization of deep cortical structures between invasive and non-invasive brain activity measured from the cortical surface. ispartof: NEUROIMAGE vol:223 ispartof: location:United States status: published

Immediately repeated meaningful pictures in a continuous recognition task induce a positive frontal potential at about 200-300 ms, which appears to emanate from the medial temporal lobe (MTL) centered on the hippocampus, as concluded from inverse solutions, coherence measurements, and depth electrode recordings in humans. In this study, we tested patients with unilateral MTL lesions due to stroke to verify the provenance of this signal and its association with the spacing effect (SE)-the improved learning of material encountered in spaced rather than massed presentation. We found that unilateral left or right MTL lesions abolished the early frontal MTL-mediated signal but not the spacing effect. We conclude that the SE does not depend on MTL integrity. We suggest that the early frontal signal at 200-300 ms after immediate picture repetition may serve as a direct biomarker of MTL integrity that may be useful in the early stages of diseases like Alzheimer's.

Background Using a stereotactic technique, surgeons can accurately place a depth electrode (DE), but sometimes the DE deviates from the intended target due to movement of the electrode or leakage of cerebrospinal fluid when placing the electrode. If DEs can be anchored before removing the catheter insertion guide pipe, more accurate placement may be possible. Methods We made a side slit guide pipe. When the DEs were anchored to the dura or the edge of the burr hole, the DE did not move when the guide pipe was removed. We measured the distance between the planned target and the tip of the electrode in 13 patients (3 female and 10 male patients; age range, 7–43 years; mean age 23.0 years; median age 27 years) with medically intractable epilepsy who underwent DE placement with stereotactic neuronavigation guidance. Results There were 30 DEs implanted. The mean distance from the planned target to the tip of the DE was 0.570 mm (range, 0.3–1.2 mm; median 0.5 mm; SD 0.212). The mean distance from the planned target to the tip of the DE with dural anchoring was 0.467 mm (range, 0.3–0.6 mm; median 0.45 mm; SD 0.121) and with burr hole edge anchoring was 0.596 mm (range, 0.3–1.2 mm; median 0.50 mm; SD 0.224; P = 0.205). Conclusions DEs can be anchored using the side slit guide pipe for more precise placement.

‘Physiological activity and artefacts in the human epileptic brain studied with intracerebral depth EEG electrodes’ reviews (i) the various expressions of normal physiological EEG activity at different sites of the brain and (ii) provides an overview of the most common artefacts that can be observed with intracerebral electrodes. All physiological rhythms known from scalp EEG can be observed in intracerebral EEG recording, but their features may change depending on the sites of the brain investigated. A recent multicentre study analysed these differences in topographical distribution using a common stereotactic space. The data are available as an open web resource. The chapter further underlines the importance of artefact identification in intracerebral EEG: Although artefacts are less frequent than in scalp EEG, non-physiological artefacts in particular may still pose problems. This chapter is written for clinical neurophysiologists, epileptologists, and researchers interested in intracerebral EEG recording.

BACKGROUND Implantation of depth electrodes to localize epileptogenic foci in patients with drug-resistant epilepsy can be accomplished using traditional rigid frame-based, custom frameless, and robotic stereotactic systems. OBJECTIVE To evaluate the accuracy of electrode implantation using the FHC microTargeting platform, a custom frameless platform, without a rigid insertion cannula. METHODS A total of 182 depth electrodes were implanted in 13 consecutive patients who underwent stereoelectroencephalography (SEEG) for drug-resistant epilepsy using the microTargeting platform and depth electrodes without a rigid guide cannula. MATLAB was utilized to evaluate targeting accuracy. Three manual coordinate measurements with high inter-rater reliability were averaged. RESULTS Patients were predominantly male (77%) with average age 35.62 (SD 11.0, range 21-57) and average age of epilepsy onset at 13.4 (SD 7.2, range 3-26). A mean of 14 electrodes were implanted (range 10-18). Mean operative time was 144 min (range 104-176). Implantation of 3 out of 182 electrodes resulted in nonoperative hemorrhage (2 small subdural hematomas and one small subarachnoid hemorrhage). Putative location of onset was identified in all patients. We demonstrated a median lateral target point localization error (LTPLE) of 3.95 mm (IQR 2.18-6.23), a lateral entry point localization error (LEPLE) of 1.98 mm (IQR 1.2-2.85), a target depth error of 1.71 mm (IQR 1.03-2.33), and total target point localization error (TPLE) of 4.95 mm (IQR 2.98-6.85). CONCLUSION Utilization of the FHC microTargeting platform without the use of insertion cannulae is safe, effective, and accurate. Localization of seizure foci was accomplished in all patients and accuracy of depth electrode placement was satisfactory.

This paper describes the electrical modulation of locomotion in pigeons using deep brain electrodes. Polymer-based depth electrodes with four channels were fabricated. Based on the location of the nucleus intercollicularis (ICo), the shanks of the depth electrodes were designed to be a length of 11 mm. After the implantation of the depth electrode into the ICo region of the brain, it was connected by wires to a custom-made stimulator, and biphasic current pulses were delivered. Current pulses with an amplitude of 0.5 mA, a rate of 58.0 Hz, and a duration of $320\mu \mathrm{s} $s were applied for 0.5 s. When the ICo region was electrically stimulated, taking-off behavior was successfully induced for 0.4 s. Induction of taking-off behavior by electrical stimulation, when coupled to control of turning and running forward locomotions, may contribute to the development of remote flight-control system of freely moving pigeon.

Summary We propose expert recommendations on the use of SEEG-guided radiofrequency thermocoagulation (RF-TC) based on an exhaustive literature review. This technique consists in performing a RF-TC lesion using a SEEG depth electrode at the end of the recording. It is indicated when conventional surgical resection of the ictal onset zone is not possible. SEEG guided RF-TC can also be considered as a diagnostic tool since an improvement, even limited, has a high positive predictive value concerning the good outcome after surgery. It is possible to perform SEEG only in the purposes of performing RF-TC. An over-implantation of the presumed ictal onset zone is possible when such a procedure is planned. The RF-TC target should only be defined based on the ictal activity, except when a type II focal cortical dysplasia electrophysiological interictal signature is recorded. A single or multiple coagulations should always be performed between contiguous electrode contacts. The power delivered by the generator should be increased until the impedance suddenly changes, which indicates that the thermocoagulation has occurred. The procedure should be performed under clinical monitoring without anesthesia and after systematically testing neurological functions by electric stimulation on each target. Multiple SEEG-guided RF-TC can be proposed in a single patient, for example, in cases of relapse after a previous effective procedure. Conventional resection surgery remains feasible after a RF-TC procedure.

Objective To evaluate motor function during neuroendoscopic resectioning of deep-seated brain tumors using endoscopically guided depth electrodes. Methods For 12 cases of thalamic tumors, including high-grade gliomas, germinomas, and malignant lymphomas, depth electrodes were inserted using endoscopic guides between the tumor and the pyramidal tract in the thalamus. Motor-evoked potentials (MEPs) were continuously recorded during neuroendoscopic resectioning of the tumors. Results Monitoring of MEP responses using depth electrodes in all 12 cases was successful. The minimum stimulus intensity threshold required to induce MEP responses was 3 mA. Gross total or subtotal resections were successful with this technique for all patients with glioma. No additional neurologic impairments were found after surgery in any of the cases. Conclusions Continuous MEP measurement using depth electrodes can serve as a new monitoring technique for endoscopic resectioning of deep-seated brain tumors.

MRI-guided thermal ablation is a relatively new technique utilising heat to ablate both tumours and epileptogenic lesions. Its use against epilepsy offers some patients a new and relatively safe way of reducing or aborting seizures. Most cases of MRI-guided thermal ablation have been performed in patients with isolated lesions. Placement of depth electrodes prior to laser ablation has been rarely performed. We present a case with bilateral independent lesions traversing eloquent cortex, which, after sampling for seizures and successful ablation, retained normal function. The patient is, to date, seizure-free.

Object Intracranial monitoring for epilepsy has been proven to enhance diagnostic accuracy and provide localizing information for surgical treatment of intractable seizures. The authors investigated the usefulness of hippocampal depth electrodes in the era of more advanced imaging techniques. Methods Between 1988 and 2010, 100 patients underwent occipitotemporal hippocampal depth electrode (OHDE) implantation as part of invasive seizure monitoring, and their charts were retrospectively reviewed. The authors' technique involved the stereotactically guided (using the Leksell model G frame) implantation of a 12-contact depth electrode directed along the long axis of the hippocampus, through an occipital twist drill hole. Results Of the 100 patients (mean age 35.0 years [range 13–58 years], 51% male) who underwent intracranial investigation, 84 underwent resection of the seizure focus. Magnetic resonance imaging revealed mesial temporal sclerosis (MTS) in 27% of patients, showed abnormal findings without MTS in 55% of patients, and showed normal findings in 18% of patients. One patient developed a small asymptomatic occipital hemorrhage around the electrode tract. The use of OHDEs enabled epilepsy resection in 45.7% of patients who eventually underwent standard or selective temporal lobe resection. The hippocampal formation was spared during surgery because data obtained from the depth electrodes showed no or only secondary involvement in 14% of patients with preoperative temporal localization. The use of OHDEs prevented resections in 12% of patients with radiographic evidence of MTS. Eighty-three percent of patients who underwent resection had Engel Class I (68%) or II (15%) outcome at 2 years of follow-up. Conclusions The use of OHDEs for intracranial epilepsy monitoring has a favorable risk profile, and in the authors' experience it proved to be a valuable component of intracranial investigation. The use of OHDEs can provide the sole evidence for resection of some epileptogenic foci and can also result in hippocampal sparing or prevent likely unsuccessful resection in other patients.

Magnetoencephalography (MEG) beamformer analyses use spatial filters to estimate neuronal activity underlying the magnetic fields measured by the MEG sensors. MEG "virtual electrodes" are the outputs of beamformer spatial filters. The present study aimed to test the hypothesis that MEG virtual electrodes can replicate the findings from intracortical "depth" electrode studies relevant to the processing of the temporal envelopes of sounds [e.g. Nourski et al. (2009) "Temporal envelope of time-compressed speech represented in the human auditory cortex," J. Neurosci. 29:15564-15574]. Specifically we aimed to determine whether it is possible to use non-invasive MEG virtual electrodes to characterise the representation of temporal envelopes of 6-Hz sinusoidal amplitude modulation (SAM) and speech using both auditory evoked fields (AEFs) and patterns of power changes in high-frequency (>70 Hz) bands. MEG signals were analysed using a location of interest (LOI) approach by seeding virtual electrodes in the left and right posteromedial Heschl's gyri. AEFs showed phase-locking to the temporal envelope of SAM and speech stimuli. Time-frequency analyses revealed no clear differences in high gamma power between the pre-stimulus baseline and the post-stimulus presentation periods. Nevertheless the patterns of changes in high gamma power were significantly correlated with the temporal envelopes of 6-Hz SAM and speech in the majority of participants. The present study reveals difficulties in replicating clear augmentations in high gamma power changes using MEG virtual electrodes cf. intracortical "depth" electrode studies (Nourski et al., 2009).