Outcome after individualized stereoelectroencephalography (sEEG) implantation and navigated resection in patients with lesional and non-lesional focal epilepsy

  • Jun Thorsteinsdottir
  • Christian Vollmar
  • Jörg-Christian Tonn
  • Friedrich-Wilhelm Kreth
  • Soheyl Noachtar
  • Aurelia PeraudEmail author
Original Communication



Refined localization of the epileptogenic zone (EZ) in patients with pharmacoresistant focal epilepsy proceeding to resective surgery might improve postoperative outcome. We here report seizure outcome after stereo EEG (sEEG) evaluation with individually planned stereotactically implanted depth electrodes and subsequent tailored resection.


A cohort of consecutive patients with pharmacoresistant focal epilepsy, evaluated with a non-invasive evaluation protocol and invasive monitoring with personalized, stereotactically implanted depth electrodes for sEEG was analyzed. Co-registration of post-implantation CT scan to presurgical MRI data was used for 3D reconstructions of the patients’ brain surface and mapping of neurophysiology data. Individual multimodal 3D maps of the EZ were used to guide subsequent tailored resections. The outcome was rated according to the Engel classification.


Out of 914 patients who underwent non-invasive presurgical evaluation, 85 underwent sEEG, and 70 were included in the outcome analysis. Median follow-up was 31.5 months. Seizure-free outcome (Engel class I A-C, ILAE class 1–2) was achieved in 83% of the study cohort. Patients exhibiting lesional and non-lesional (n = 42, 86% vs. n = 28, 79%), temporal and extratemporal (n = 45, 80% vs. n = 25, 84%), and right- and left-hemispheric epilepsy (n = 44, 82% vs. n = 26, 85%) did similarly well. This remains also true for those with an EZ adjacent to or distant from eloquent cortex (n = 21, 86% vs. n = 49, 82%). Surgical outcome was independent of resected tissue volume.


Favourable post-surgical outcome can be achieved in patients with resistant focal epilepsy, using individualized sEEG evaluation and tailored navigated resection, even in patients with non-lesional or extratemporal focal epilepsy.


Epilepsy Depth electrodes sEEG Navigation Lesional 


Compliance with ethical standards

Conflicts of interest

JCT discloses support for counselling and travel grants by Brainlab.

Ethical standard

The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all patients.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jun Thorsteinsdottir
    • 1
  • Christian Vollmar
    • 2
  • Jörg-Christian Tonn
    • 1
  • Friedrich-Wilhelm Kreth
    • 1
  • Soheyl Noachtar
    • 2
  • Aurelia Peraud
    • 1
    • 3
    Email author
  1. 1.Department of NeurosurgeryUniversity Hospital of Munich, Ludwig-Maximilians-UniversityMunichGermany
  2. 2.Department of NeurologyUniversity Hospital of Munich, Ludwig-Maximilians-UniversityMunichGermany
  3. 3.Department of NeurosurgeryUniversity Hospital of UlmUlmGermany

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