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González-Martínez J, Bulacio J, Thompson S, Gale J, Smithason S, Najm I, Bingaman W. Technique, Results, and Complications Related to Robot-Assisted Stereoelectroencephalography. Neurosurgery 2015; 78:169-80. [DOI: 10.1227/neu.0000000000001034] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
BACKGROUND:
Robot-assisted stereoelectroencephalography (SEEG) may represent a simplified, precise, and safe alternative to the more traditional SEEG techniques.
OBJECTIVE:
To report our clinical experience with robotic SEEG implantation and to define its utility in the management of patients with medically refractory epilepsy.
METHODS:
The prospective observational analyses included all patients with medically refractory focal epilepsy who underwent robot-assisted stereotactic placement of depth electrodes for extraoperative brain monitoring between November 2009 and May 2013. Technical nuances of the robotic implantation technique are presented, as well as an analysis of demographics, time of planning and procedure, seizure outcome, in vivo accuracy, and procedure-related complications.
RESULTS:
One hundred patients underwent 101 robot-assisted SEEG procedures. Their mean age was 33.2 years. In total, 1245 depth electrodes were implanted. On average, 12.5 electrodes were implanted per patient. The time of implantation planning was 30 minutes on average (range, 15-60 minutes). The average operative time was 130 minutes (range, 45-160 minutes). In vivo accuracy (calculated in 500 trajectories) demonstrated a median entry point error of 1.2 mm (interquartile range, 0.78-1.83 mm) and a median target point error of 1.7 mm (interquartile range, 1.20-2.30 mm). Of the group of patients who underwent resective surgery (68 patients), 45 (66.2%) gained seizure freedom status. Mean follow-up was 18 months. The total complication rate was 4%.
CONCLUSION:
The robotic SEEG technique and method were demonstrated to be safe, accurate, and efficient in anatomically defining the epileptogenic zone and subsequently promoting sustained seizure freedom status in patients with difficult-to-localize seizures.
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Affiliation(s)
- Jorge González-Martínez
- Epilepsy Center and Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Juan Bulacio
- Epilepsy Center and Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Susan Thompson
- Epilepsy Center and Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Gale
- Epilepsy Center and Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Saksith Smithason
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Imad Najm
- Epilepsy Center and Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - William Bingaman
- Epilepsy Center and Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Faria C, Erlhagen W, Rito M, De Momi E, Ferrigno G, Bicho E. Review of Robotic Technology for Stereotactic Neurosurgery. IEEE Rev Biomed Eng 2015; 8:125-37. [DOI: 10.1109/rbme.2015.2428305] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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