Stereo-Electroencephalography Using Magnetic Resonance Angiography for Avascular Trajectory Planning.

Background: Stereo-electroencephalography (SEEG) requires high quality angiographic study because avascular trajectory planning is a prerequisite for the safety of this procedure. Some epilepsy surgery groups have started to use computed tomography angiography (CTA) and magnetic resonance T1- weighted sequence with contrast enhancement (CE T1). To the best of our knowledge there are no reports of avascular trajectory planning of SEEG based on magnetic resonance angiography (MRA). Objective: The goal of our study was to assess the quality and safety of MRA for avascular trajectory planning of SEEG. Methods: Thirty-six SEEG explorations for drug-resistant focal epilepsy have been performed from January 2013 to December 2015 in the Epilepsy Surgery Center in Sofia. MRI included MRA with modified contrast enhanced magnetic resonance venography (MRV) protocol with short acquisition delay allowing simultaneous arterial and venous visualization. Our criteria for satisfactory MRA were visualization of at least first-order branches of the angular artery, paracentral and calcarine artery and thirdorder tributaries of superficial Sylvian vein, vein of Labbe and vein of Trolard. Results: Thirty-four patients underwent thirty-six SEEG explorations with 369 electrodes carrying 4321 contacts. Contrast enhanced MRA using MRVprotocol was judged satisfactory for SEEG planning in all explorations. Postoperative complications were not observed in our series of 36 SEEG explorations. Conclusions: MRA using MRV protocol may be applied for avascular trajectory planning during SEEG procedures and appears to have satisfactory safety profile. This technique provides simultaneous visualisation of cortical arteries and veins without need of additional radiation exposure or intra-arterial catheter placement. [ABSTRACT FROM AUTHOR]