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Accuracy of intracranial electrode placement for stereoencephalography: A systematic review and meta-analysis

Research output: Contribution to journalReview article

Vejay N. Vakharia, Rachel Sparks, Aidan G. O'Keeffe, Roman Rodionov, Anna Miserocchi, Andrew McEvoy, Sebastien Ourselin, John Duncan

Original languageEnglish
Pages (from-to)921-932
Number of pages12
Issue number6
Early online date6 Mar 2017
Publication statusPublished - Jun 2017


  • Accuracy of intracranial electrode_VAKHARIA_Firstonline6March2017_GREEN AAM

    Accuracy_of_intracranial_electrode_VAKHARIA_Firstonline6March2017_GREEN_AAM.pdf, 594 KB, application/pdf


    Accepted author manuscript

    This is the peer reviewed version of the following article: Vakharia, V. N., Sparks, R. , O'Keeffe, A. G., Rodionov, R. , Miserocchi, A. , McEvoy, A. , Ourselin, S. and Duncan, J. (2017), Accuracy of intracranial electrode placement for stereoelectroencephalography: A systematic review and meta‐analysis. Epilepsia, 58: 921-932., which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.


King's Authors


Objective: Stereoencephalography (SEEG) is a procedure in which electrodes are inserted into the brain to help define the epileptogenic zone. This is performed prior to definitive epilepsy surgery in patients with drug-resistant focal epilepsy when noninvasive data are inconclusive. The main risk of the procedure is hemorrhage, which occurs in 1–2% of patients. This may result from inaccurate electrode placement or a planned electrode damaging a blood vessel that was not detected on the preoperative vascular imaging. Proposed techniques include the use of a stereotactic frame, frameless image guidance systems, robotic guidance systems, and customized patient-specific fixtures. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a structured search of the PubMed, Embase, and Cochrane databases identified studies that involve the following: (1) SEEG placement as part of the presurgical workup in patients with (2) drug-resistant focal epilepsy for which (3) accuracy data have been provided. Results: Three hundred twenty-six publications were retrieved, of which 293 were screened following removal of duplicate and non–English-language studies. Following application of the inclusion and exclusion criteria, 15 studies were included in the qualitative and quantitative synthesis of the meta-analysis. Accuracies for SEEG electrode implantations have been combined using a random-effects analysis and stratified by technique. Significance: The published literature regarding accuracy of SEEG implantation techniques is limited. There are no prospective controlled clinical trials comparing different SEEG implantation techniques. Significant systematic heterogeneity exists between the identified studies, preventing any meaningful comparison between techniques. The recent introduction of robotic trajectory guidance systems has been suggested to provide a more accurate method of implantation, but supporting evidence is limited to class 3 only. It is important that new techniques are compared to the previous “gold-standard” through well-designed and methodologically sound studies before they are introduced into widespread clinical practice.

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