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Kang S, Zhao C, Fan Y. Puncture and Drainage Surgery for Intracerebral Hemorrhage Guided by 3D Printing Puncture Guide Plate. J Craniofac Surg 2024; 35:1264-1267. [PMID: 38363294 DOI: 10.1097/scs.0000000000010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVES Accurate puncture is the key to ensure the effect of puncture and drainage surgery for intracerebral hemorrhage. It usually uses CT to guide the drainage tube to reach the center of the hematoma cavity, which has the problems of inaccurate positioning using 2D images and high requirements for surgeon's experience in brain anatomy and imaging diagnosis. The aim of this study was to use a 3D printing puncture guide plate to guide the puncture and drainage surgery for intracerebral hemorrhage. METHODS The CT images were imported into 3D Slicer software to reconstruct 3D models of the head skin and intracerebral hematoma. The target was set in the center of the hematoma and the puncture path from the target to the entry point was designed, the 3D model of puncture guide plate was constructed and saved as stereolithography format file, which was imported into 3D printer to print. During surgery, the drainage tube was placed in the center of the hematoma guided by the 3D printing puncture guide plate, and the blood clot was extracted by the suction syringe. RESULTS Eight patients with hypertensive intracerebral hemorrhage were treated with puncture and drainage surgery guided by 3D printing puncture guide plate. The average operation time of the 8 surgeries was 17.63 minutes. The drainage tubes were all precisely placed in the center of the hematoma, and the blood clots were all successfully extracted. The positioning errors of the 8 drainage tubes were between 1.76 mm and 2.68 mm, and the mean value was 2.10±0.32 mm. The hematoma clearance rate of the 8 patients was between 74.18% and 96.73%, and the mean value was 85.14±6.71%. CONCLUSIONS The puncture and drainage surgery for intracerebral hemorrhage guided by 3D printing puncture guide plate helps to quickly and effortlessly localize intracerebral hematoma and achieves satisfactory hematoma clearance rate.
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Affiliation(s)
- Shengyu Kang
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Chengle Zhao
- Department of Neurosurgery, Zhenping People's Hospital, Nanyang, China
| | - Yifeng Fan
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, Zhejiang, China
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Kaewborisutsakul A, Chernov M, Yokosako S, Kubota Y. Usefulness of Robotic Stereotactic Assistance (ROSA ®) Device for Stereoelectroencephalography Electrode Implantation: A Systematic Review and Meta-analysis. Neurol Med Chir (Tokyo) 2024; 64:71-86. [PMID: 38220166 PMCID: PMC10918457 DOI: 10.2176/jns-nmc.2023-0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/17/2023] [Indexed: 01/16/2024] Open
Abstract
The aim of this study was to systematically review and meta-analyze the efficiency and safety of using the Robotic Stereotactic Assistance (ROSA®) device (Zimmer Biomet; Warsaw, IN, USA) for stereoelectroencephalography (SEEG) electrode implantation in patients with drug-resistant epilepsy. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was carried out. Overall, 855 nonduplicate relevant articles were determined, and 15 of them were selected for analysis. The benefits of the ROSA® device use in terms of electrode placement accuracy, as well as operative time length, perioperative complications, and seizure outcomes, were evaluated. Studies that were included reported on a total of 11,257 SEEG electrode implantations. The limited number of comparative studies hindered the comprehensive evaluation of the electrode implantation accuracy. Compared with frame-based or navigation-assisted techniques, ROSA®-assisted SEEG electrode implantation provided significant benefits for reduction of both overall operative time (mean difference [MD], -63.45 min; 95% confidence interval [CI] from -88.73 to -38.17 min; P < 0.00001) and operative time per implanted electrode (MD, -8.79 min; 95% CI from -14.37 to -3.21 min; P = 0.002). No significant differences existed in perioperative complications and seizure outcomes after the application of the ROSA® device and other techniques for electrode implantation. To conclude, the available evidence shows that the ROSA® device is an effective and safe surgical tool for trajectory-guided SEEG electrode implantation in patients with drug-resistant epilepsy, offering benefits for saving operative time and neither increasing the risk of perioperative complications nor negatively impacting seizure outcomes.
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Affiliation(s)
- Anukoon Kaewborisutsakul
- Neurological Surgery Unit, Division of Surgery, Faculty of Medicine, Prince of Songkla University
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
| | - Mikhail Chernov
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
| | - Suguru Yokosako
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
| | - Yuichi Kubota
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
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3
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Mutoh M, Maesawa S, Nakatsubo D, Ishizaki T, Tanei T, Torii J, Ito Y, Hashida M, Saito R. Boltless nylon-suture technique for stereotactic electroencephalography as a safe, effective alternative when the anchor bolt is inappropriate. Acta Neurochir (Wien) 2024; 166:18. [PMID: 38231293 DOI: 10.1007/s00701-024-05889-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/23/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND The use of anchor bolts to secure electrodes to the skull can be difficult in some clinical situations. Herein, we present the boltless technique to secure electrodes to the scalp using nylon sutures to overcome the problems associated with anchor bolts. We investigated the safety, accuracy errors, and patient-related and operative factors affecting errors in the boltless technique. METHODS This single-institution retrospective series analyzed 103 electrodes placed in 12 patients. The target-point localization error (TPLE), entry-point localization error (EPLE), radial error (RE), and depth error (DE) of the electrodes were calculated. RESULTS The median of the mean operative time per electrode was 9.3 min. The median TPLE, EPLE, RE, and absolute DE value were 4.1 mm, 1.6 mm, 2.7 mm, and 1.9 mm, respectively. Positive correlations were observed between the preoperative scalp thickness, mean operative time per electrode, EPLE, RE, and the absolute value of DE versus TPLE (r = .228, p = .02; r = .678, p = .015; r = .228, p = .02; r = .445, p < .01; r = .630, p < .01, respectively), and electrode approach angle versus EPLE (r = .213, p = .031). Multivariate analysis revealed that the absolute value of DE had the strongest influence on the TPLE, followed by RE and preoperative scalp thickness, respectively (β = .938, .544, .060, respectively, p < .001). No complications related to SEEG insertion and monitoring were encountered. CONCLUSION The boltless technique using our unique planning and technical method is a safe, effective, and low-cost alternative in cases where anchor bolts are contraindicated.
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Affiliation(s)
- Manabu Mutoh
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 4668650, Japan
| | - Satoshi Maesawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 4668650, Japan.
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan.
| | - Daisuke Nakatsubo
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 4668650, Japan
- Focused Ultrasound Therapy Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Tomotaka Ishizaki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 4668650, Japan
| | - Takafumi Tanei
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 4668650, Japan
| | - Jun Torii
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 4668650, Japan
| | - Yoshiki Ito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 4668650, Japan
| | - Miki Hashida
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 4668650, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 4668650, Japan
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Xu Y, Chen Y, Liu H, Zhang H, Yin Z, Liu D, Zhu G, Diao Y, Wu D, Xie H, Hu W, Zhang X, Shao X, Zhang K, Zhang J, Yang A. The clinical application of neuro-robot in the resection of epileptic foci: a novel method assisting epilepsy surgery. J Robot Surg 2023; 17:2259-2269. [PMID: 37308790 DOI: 10.1007/s11701-023-01615-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/13/2023] [Indexed: 06/14/2023]
Abstract
During surgery for foci-related epilepsy, neurosurgeons face significant difficulties in identifying and resecting MRI-negative or deep-seated epileptic foci. Here, we present a neuro-robotic navigation system that is specifically designed for resection of MRI negative epileptic foci. We recruited 52 epileptic patients, and randomly assigned them to treatment group with either neuro-robotic navigation or conventional neuronavigation system. For each patient, in the neuro-robotic navigation group, we integrated multimodality imaging including MRI and PET-CT into the robotic workstation and marked the boundary of foci from the fused image. During surgery, this boundary was delineated by the robotic laser device with high accuracy, guiding resection for the surgeon. For deeply seated foci, we exploited the neuro-robotic navigation system to localize the deepest point with biopsy needle insertion and methylene dye application to locate the boundary of the foci. Our results show that, compared with the conventional neuronavigation, the neuro-robotic navigation system performs equally well in MRI positive epilepsy patients (ENGEL I ratio: 71.4% vs 100%, p = 0.255) systems and show better performance in patients with MRI-negative focal cortical dysplasia (ENGEL I ratio: 88.2% vs 50%, p = 0.0439). At present, there are no documented neurosurgery robots with similar function and application in the field of epilepsy. Our research highlights the added value of using neuro-robotic navigation systems in resection surgery for epilepsy, particularly in cases that involve MRI-negative or deep-seated epileptic foci.
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Affiliation(s)
- Yichen Xu
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yingchuan Chen
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Huanguang Liu
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Hua Zhang
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zixiao Yin
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Defeng Liu
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Guanyu Zhu
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yu Diao
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Delong Wu
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Hutao Xie
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Wenhan Hu
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xin Zhang
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China
| | - Xiaoqiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Kai Zhang
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Jianguo Zhang
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China.
| | - Anchao Yang
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China.
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Vasconcellos FDN, Almeida T, Müller Fiedler A, Fountain H, Santos Piedade G, Monaco BA, Jagid J, Cordeiro JG. Robotic-Assisted Stereoelectroencephalography: A Systematic Review and Meta-Analysis of Safety, Outcomes, and Precision in Refractory Epilepsy Patients. Cureus 2023; 15:e47675. [PMID: 38021558 PMCID: PMC10672406 DOI: 10.7759/cureus.47675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Robotic assistance in stereoelectroencephalography (SEEG) holds promising potential for enhancing accuracy, efficiency, and safety during electrode placement and surgical procedures. This systematic review and meta-analysis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and International Prospective Register of Systematic Reviews (PROSPERO) registration, delves into the latest advancements and implications of robotic systems in SEEG, while meticulously evaluating outcomes and safety measures. Among 855 patients suffering from medication-refractory epilepsy who underwent SEEG in 29 studies, averaging 24.6 years in age, the most prevalent robots employed were robotic surgical assistant (ROSA) (450 patients), Neuromate (207), Sinovation (140), and ISys1 (58). A total of 8,184 electrodes were successfully implanted, with an average operative time of 157.2 minutes per procedure and 15.1 minutes per electrode, resulting in an overall mean operative time of 157.7 minutes across all studies. Notably, the mean target point error (TPE) stood at 2.13 mm, the mean entry point error (EPE) at 1.48 mm, and postoperative complications occurred in 7.69% of robotically assisted (RA) SEEG cases (60), with 85% of these complications being asymptomatic. This comprehensive analysis underscores the safety and efficacy of RA-SEEG in patients with medication-refractory epilepsy, characterized by low complication rates, reduced operative time, and precise electrode placement, supporting its widespread adoption in clinical practice, with no discernible differences noted among the various robotic systems.
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Affiliation(s)
| | - Timoteo Almeida
- Department of Neurosurgery, University of Miami, Miami, USA
- Department of Radiation Oncology, University of Miami, Miami, USA
| | | | - Hayes Fountain
- Department of Neurosurgery, University of Miami, Miami, USA
| | | | - Bernardo A Monaco
- Department of Neurological Surgery, University of Miami, Miami, USA
- Department of Neurological Surgery, CDF (Clinica de Dor e Funcional), Sao Paulo, BRA
- Department of Neurological Surgery, University of Sao Paulo, Sao Paulo, BRA
| | - Jonathan Jagid
- Department of Neurological Surgery, University of Miami, Miami, USA
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Gorbachuk M, Machetanz K, Weinbrenner E, Grimm F, Wuttke TV, Wang S, Ethofer S, Tatagiba M, Rona S, Honegger J, Naros G. Robot-assisted stereoencephalography vs subdural electrodes in the evaluation of temporal lobe epilepsy. Epilepsia Open 2023; 8:888-897. [PMID: 37149851 PMCID: PMC10472365 DOI: 10.1002/epi4.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/30/2023] [Indexed: 05/09/2023] Open
Abstract
OBJECTIVE Invasive video-electroencephalography (iVEEG) is the gold standard for evaluation of refractory temporal lobe epilepsy before second stage resective surgery (SSRS). Traditionally, the presumed seizure onset zone (SOZ) has been covered with subdural electrodes (SDE), a very invasive procedure prone to complications. Temporal stereoelectroencephalography (SEEG) with conventional frame-based stereotaxy is time-consuming and impeded by the geometry of the frame. The introduction of robotic assistance promised a simplification of temporal SEEG implantation. However, the efficacy of temporal SEEG in iVEEG remains unclear. The aim of this study was therefore to describe the efficiency and efficacy of SEEG in iVEEG of temporal lobe epilepsy. METHODS This retrospective study enrolled 60 consecutive patients with medically intractable epilepsy who underwent iVEEG of a potential temporal SOZ by SDE (n = 40) or SEEG (n = 20). Surgical time efficiency was analyzed by the skin-to-skin time (STS) and the total procedure time (TPT) and compared between groups (SDE vs SEEG). Surgical risk was depicted by the 90-day complication rate. Temporal SOZ were treated by SSRS. Favorable outcome (Engel°1) was assessed after 1 year of follow-up. RESULTS Robot-assisted SEEG significantly reduced the duration of surgery (STS and TPT) compared to SDE implantations. There was no significant difference in complication rates. Notably, all surgical revisions in this study were attributed to SDE. Unilateral temporal SOZ was detected in 34/60 cases. Of the 34 patients, 30 underwent second stage SSRS. Both SDE and SEEG had a good predictive value for the outcome of temporal SSRS with no significant group difference. SIGNIFICANCE Robot-assisted SEEG improves the accessibility of the temporal lobe for iVEEG by increasing surgical time efficiency and by simplifying trajectory selection without losing its predictive value for SSRS.
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Affiliation(s)
- Mykola Gorbachuk
- Neurosurgical Clinic, Department of Neurosurgery and NeurotechnologyEberhard Karls UniversityTuebingenGermany
| | - Kathrin Machetanz
- Neurosurgical Clinic, Department of Neurosurgery and NeurotechnologyEberhard Karls UniversityTuebingenGermany
| | - Eliane Weinbrenner
- Neurosurgical Clinic, Department of Neurosurgery and NeurotechnologyEberhard Karls UniversityTuebingenGermany
| | - Florian Grimm
- Neurosurgical Clinic, Department of Neurosurgery and NeurotechnologyEberhard Karls UniversityTuebingenGermany
| | - Thomas V. Wuttke
- Neurosurgical Clinic, Department of Neurosurgery and NeurotechnologyEberhard Karls UniversityTuebingenGermany
| | - Sophie Wang
- Neurosurgical Clinic, Department of Neurosurgery and NeurotechnologyEberhard Karls UniversityTuebingenGermany
| | - Silke Ethofer
- Neurosurgical Clinic, Department of Neurosurgery and NeurotechnologyEberhard Karls UniversityTuebingenGermany
| | - Marcos Tatagiba
- Neurosurgical Clinic, Department of Neurosurgery and NeurotechnologyEberhard Karls UniversityTuebingenGermany
| | - Sabine Rona
- Neurosurgical Clinic, Department of Neurosurgery and NeurotechnologyEberhard Karls UniversityTuebingenGermany
| | - Jürgen Honegger
- Neurosurgical Clinic, Department of Neurosurgery and NeurotechnologyEberhard Karls UniversityTuebingenGermany
| | - Georgios Naros
- Neurosurgical Clinic, Department of Neurosurgery and NeurotechnologyEberhard Karls UniversityTuebingenGermany
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Williams A, Ordaz JD, Budnick H, Desai VR, Tailor J, Raskin JS. Accuracy of Depth Electrodes is Not Time-Dependent in Robot-Assisted Stereoelectroencephalography in a Pediatric Population. Oper Neurosurg (Hagerstown) 2023; 25:269-277. [PMID: 37219595 DOI: 10.1227/ons.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/21/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Robot-assisted stereoelectroencephalography (sEEG) is steadily supplanting traditional frameless and frame-based modalities for minimally invasive depth electrode placement in epilepsy workup. Accuracy rates similar to gold-standard frame-based techniques have been achieved, with improved operative efficiency. Limitations in cranial fixation and placement of trajectories in pediatric patients are believed to contribute to a time-dependent accumulation of stereotactic error. Thus, we aim to study the impact of time as a marker of cumulative stereotactic error during robotic sEEG. METHODS All patients between October 2018 and June 2022 who underwent robotic sEEG were included. Radial errors at entry and target points as well as depth and Euclidean distance errors were collected for each electrode, excluding those with errors over 10 mm. Target point errors were standardized by planned trajectory length. ANOVA and error rates over time were analyzed using GraphPad Prism 9. RESULTS Forty-four patients met inclusion criteria for a total of 539 trajectories. Number of electrodes placed ranged from 6 to 22. Average root mean squared error was 0.45 ± 0.12 mm. Average entry, target, depth, and Euclidean distance errors were 1.12 ± 0.41 mm, 1.46 ± 0.44 mm, -1.06 ± 1.43 mm, and 3.01 ± 0.71 mm, respectively. There was no significant increased error with each sequential electrode placed (entry error P -value = .54, target error P -value = .13, depth error P -value = .22, Euclidean distance P -value = .27). CONCLUSION No decremental accuracy over time was observed. This may be secondary to our workflow which prioritizes oblique and longer trajectories first and then into less error-prone trajectories. Further study on the effect of level of training may reveal a novel difference in error rates.
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Affiliation(s)
- Ari Williams
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Josue D Ordaz
- Department of Neurological Surgery, Section of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hailey Budnick
- Department of Neurological Surgery, Section of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Virendra R Desai
- Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Jignesh Tailor
- Department of Neurological Surgery, Section of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeffrey S Raskin
- Department of Neurosurgery, Section of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
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Yindeedej V, Uda T, Kawashima T, Koh S, Tanoue Y, Kojima Y, Goto T. Electrode Tip Shift During the Stereotactic Electroencephalography Evaluation Period with Boltless Suture Fixation. World Neurosurg 2023; 175:e1210-e1219. [PMID: 37427700 DOI: 10.1016/j.wneu.2023.04.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/24/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Electrodes for stereotactic electroencephalography (SEEG) are typically fixed to the skull with anchor bolts. When anchor bolts are unavailable, electrodes have to be fixed using other methods, carrying the possibility of electrode shift. This study, therefore, evaluated the characteristics of electrode tip shift during SEEG monitoring in patients with electrodes fixed using the suture technique. METHODS We retrospectively included patients who underwent SEEG implantation with suture fixation and evaluated the tip shift distance (TSD) of electrodes. Possible influences evaluated included: 1) implantation period, 2) lobe of entry, 3) unilateral or bilateral implantation, 4) electrode length, 5) skull thickness, and 6) scalp thickness difference. RESULTS A total of 50 electrodes in 7 patients were evaluated. TSD was 1.4 ± 2.0 mm (mean ± standard deviation). Implantation period was 8.1 ± 2.2 days. Entry lobe was frontal for 28 electrodes and temporal for 22 electrodes. Implantation was bilateral for 25 electrodes and unilateral for 25 electrodes. Electrode length was 45.4 ± 14.3 mm. Skull thickness was 6.0 ± 3.7 mm. Scalp thickness difference was -1.5 ± 2.1 mm, which was found greater in temporal lobe entry compared with frontal lobe entry. According to univariate analyses, neither implantation period nor electrode length correlated with TSD. Multivariate regression analysis showed that only greater scalp thickness difference correlated significantly with greater TSD (P = 0.0018). CONCLUSIONS Greater scalp thickness difference correlated with greater TSD. Surgeons need to consider the degree of scalp thickness difference and electrode shift when using suture fixation, especially with temporal lobe entry.
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Affiliation(s)
- Vich Yindeedej
- Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan; Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Takehiro Uda
- Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan.
| | - Toshiyuki Kawashima
- Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Saya Koh
- Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Yuta Tanoue
- Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Yuichiro Kojima
- Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Takeo Goto
- Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
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9
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Gomes FC, Larcipretti ALL, Nager G, Dagostin CS, Udoma-Udofa OC, Pontes JPM, de Oliveira JS, de Souza JHC, Bannach MDA. Robot-assisted vs. manually guided stereoelectroencephalography for refractory epilepsy: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:102. [PMID: 37133774 DOI: 10.1007/s10143-023-01992-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/15/2023] [Accepted: 04/06/2023] [Indexed: 05/04/2023]
Abstract
Robotic assistance has improved electrode implantation precision in stereoelectroencephalography (SEEG) for refractory epilepsy patients. We sought to assess the relative safety of the robotic-assisted (RA) procedure compared to the traditional hand-guided one. A systematic search on PubMed, Web of Science, Embase, and Cochrane was performed for studies directly comparing robot-assisted vs. manually guided SEEG to treat refractory epilepsy. The primary outcomes included target point error (TPE), entry point error (EPE), time of implantation of each electrode, operative time, postoperative intracranial hemorrhage, infection, and neurologic deficit. We included 427 patients from 11 studies, of whom 232 (54.3%) underwent robot-assisted surgery and 196 (45.7%) underwent manually guided surgery. The primary endpoint, TPE, was not statistically significant (MD 0.04 mm; 95% CI - 0.21, - 0.29; p = 0.76). Nonetheless, EPE was significantly lower in the intervention group (MD - 0.57 mm; 95% CI - 1.08; - 0.06; p = 0.03). Total operative time was significantly lower in the RA group (MD - 23.66 min; 95% CI - 32.01, - 15.31; p < 0.00001), as well as the individual time of implantation of each electrode (MD - 3.35 min; 95% CI - 3.68, - 3.03; p < 0.00001). Postoperative intracranial hemorrhage did not differ between groups: robotic (9/145; 6.2%) vs. manual (8/139; 5.7%) (RR 0.97; 95% CI 0.40-2.34; p = 0.94). There was no statistically relevant difference in infection (p = 0.4) and postoperative neurological deficit (p = 0.47) incidence between the two groups. In this analysis, there is a potential relevance in the RA procedure when comparing the traditional one, since operative time, time of implantation of each electrode, and EPE were significantly lower in the robotic group. More research is needed to corroborate the superiority of this novel technique.
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Affiliation(s)
| | | | - Gabriela Nager
- Department of Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Matheus de Andrade Bannach
- Department of Surgery, Neurology and Neurosurgery Unit, Federal University of Goiás, Goiânia, 74690-900, Brazil.
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10
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A comparison between robot-guided and stereotactic frame-based stereoelectroencephalography (SEEG) electrode implantation for drug-resistant epilepsy. J Robot Surg 2022; 17:1013-1020. [DOI: 10.1007/s11701-022-01504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
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11
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Samanta D. Recent developments in stereo electroencephalography monitoring for epilepsy surgery. Epilepsy Behav 2022; 135:108914. [PMID: 36116362 DOI: 10.1016/j.yebeh.2022.108914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 11/03/2022]
Abstract
Recently the utilization of the stereo electroencephalography (SEEG) method has exploded globally. It is now the preferred method of intracranial monitoring for epilepsy. Since its inception, the basic tenet of the SEEG method remains the same: strategic implantation of intracerebral electrodes based on a hypothesis grounded on anatomo-electroclinical correlation, interpretation of interictal and ictal abnormalities, and formation of a surgical plan based on these data. However, there are recent advancements in all these domains-electrodes implantations, data interpretation, and therapeutic strategy- that can make the SEEG a more accessible and effective approach. In this narrative review, these newer developments are discussed and summarized. Regarding implantation, efficient commercial robotic systems are now increasingly available, which are also more accurate in implanting electrodes. In terms of ictal and interictal abnormalities, newer studies focused on correlating these abnormalities with pathological substrates and surgical outcomes and analyzing high-frequency oscillations and cortical-subcortical connectivity. These abnormalities can now be further quantified using advanced tools (spectrum, spatiotemporal, connectivity analysis, and machine learning algorithms) for objective and efficient interpretation. Another aspect of recent development is renewed interest in SEEG-based electrical stimulation mapping (ESM). The SEEG-ESM has been used in defining epileptogenic networks, mapping eloquent cortex (primarily language), and analyzing cortico-cortical evoked potential. Regarding SEEG-guided direct therapeutic strategy, several clinical studies evaluated the use of radiofrequency thermocoagulation. As the emerging SEEG-based diagnosis and therapeutics are better evolved, treatments aimed at specific epileptogenic networks without compromising the eloquent cortex will become more easily accessible to improve the lives of individuals with drug-resistant epilepsy (DRE).
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
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Complications in stereoelectroencephalography: are we too severe? Acta Neurochir (Wien) 2021; 163:3041-3043. [PMID: 34117559 DOI: 10.1007/s00701-021-04878-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
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Fogg DN, Mallela AN, Abou-Al-Shaar H, González-Martínez J. Robotic-assisted stereotactic drainage of cerebral abscess and placement of ventriculostomy. Br J Neurosurg 2021:1-4. [PMID: 34463595 DOI: 10.1080/02688697.2021.1969006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Robotic surgery has found increasing use in multiple subfields of neurosurgery. While the initial applications of stereotactic robotic surgery were for the placement of electrodes for extra-operative seizure monitoring, this technique has become increasingly relevant in other areas of neurosurgery. To the best of our knowledge, we report the first case of successful robotic surgery utilization to drain a cerebral abscess and place an external ventricular drain. CASE REPORT The authors demonstrate a novel use for stereotactic robotic assistance to drain a cerebral abscess and place ventriculostomy in a 74-year-old female patient who presented with a left basal ganglia Streptococcus intermedius abscess and concomitant ventriculitis. Drainage of a deep-seated abscess and placement of ventriculostomy was successfully performed in this patient without intraoperative difficulties or complications. The total operative time, including registration was 64 minutes and the estimated blood loss was 25 mL. The patient recovered well and was discharged to inpatient rehabilitation on postoperative day 19. CONCLUSIONS The use of robotic surgery to drain cerebral abscesses and place ventriculostomies is technically feasible and may potentially decrease operative time and increase accuracy and safety.
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Affiliation(s)
- David N Fogg
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arka N Mallela
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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