1
|
Fujimoto S, Matsuo T, Nakata Y, Shiojima H. Real-time display of intracranial subdural electrodes and the brain surface during an electrode implantation procedure using permeable film. Surg Neurol Int 2024; 15:190. [PMID: 38974543 PMCID: PMC11225510 DOI: 10.25259/sni_74_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/15/2024] [Indexed: 07/09/2024] Open
Abstract
Background Subdural electrode (SDE) implantation is an important method of diagnosing epileptogenic lesions and mapping brain function, even with the current preference for stereoelectroencephalography. We developed a novel method to assess SDEs and the brain surface during the electrode implantation procedure using brain images printed onto permeable films and intraoperative fluoroscopy. This method can help verify the location of the electrode during surgery and improve the accuracy of SDE implantation. Methods We performed preoperative imaging by magnetic resonance imaging and computed tomography. Subsequently, the images were edited and fused to visualize the gyrus and sulcus better. We printed the images on permeable films and superimposed them on the intraoperative fluoroscopy display. The intraoperative and postoperative coordinates of the electrodes were obtained after the implantation surgery, and the differences in the locations were calculated. Results Permeable films were created for a total of eight patients with intractable epilepsy. The median difference of the electrodes between the intraoperative and postoperative images was 4.6 mm (Interquartile range 2.9-7.1). The locations of electrodes implanted outside the operation field were not significantly different from those implanted inside. Conclusion Our new method may guide the implantation of SDEs into their planned location.
Collapse
Affiliation(s)
- So Fujimoto
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Takeshi Matsuo
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Yasuhiro Nakata
- Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Honoka Shiojima
- Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| |
Collapse
|
2
|
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.
Collapse
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
| | | |
Collapse
|
3
|
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: 6] [Impact Index Per Article: 6.0] [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.
Collapse
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.
| |
Collapse
|
4
|
Pakozdy A, Halasz P, Klang A, Lörincz BA, Schmidt MJ, Glantschnigg-Eisl U, Binks S. Temporal lobe epilepsy in cats. Vet J 2023; 291:105941. [PMID: 36549606 DOI: 10.1016/j.tvjl.2022.105941] [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: 02/14/2022] [Revised: 12/02/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
In recent years there has been increased attention to the proposed entity of feline temporal lobe epilepsy (TLE). Epileptic discharges in certain parts of the temporal lobe elicit very similar semiology, which justifies grouping these epilepsies under one name. Furthermore, feline TLE patients tend to have histopathological changes within the temporal lobe, usually in the hippocampus. The initial aetiology is likely to be different but may result in hippocampal necrosis and later hippocampal sclerosis. The aim of this article was not only to summarise the clinical features and the possible aetiology, but also being work to place TLE within the veterinary epilepsy classification. Epilepsies in cats, similar to dogs, are classified based on the aetiology into idiopathic epilepsy, structural epilepsy and unknown cause. TLE seems to be outside of this classification, as it is not an aetiologic category, but a syndrome, associated with a topographic affiliation to a certain anatomical brain structure. Magnetic resonance imaging, histopathologic aspects and current medical therapeutic considerations will be summarised, and emerging surgical options are discussed.
Collapse
Affiliation(s)
- Akos Pakozdy
- University Clinic for Small Animals, University of Veterinary Medicine, Vienna, Austria.
| | - Peter Halasz
- Institute of Experimental Medicine, Budapest, Hungary
| | - Andrea Klang
- Institute of Pathology, University of Veterinary Medicine, Austria
| | - Borbala A Lörincz
- Clinic of Diagnostic Imaging, University of Veterinary Medicine Vienna, Austria
| | - Martin J Schmidt
- Department of Veterinary Clinical Sciences, Small Animal Clinic-Neurosurgery, Neuroradiology and Clinical Neurology, Justus-Liebig-University, Germany
| | | | - Sophie Binks
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| |
Collapse
|
5
|
Kojima Y, Uda T, Kawashima T, Koh S, Hattori M, Mito Y, Kunihiro N, Ikeda S, Umaba R, Goto T. Primary Experiences with Robot-assisted Navigation-based Frameless Stereo-electroencephalography: Higher Accuracy than Neuronavigation-guided Manual Adjustment. Neurol Med Chir (Tokyo) 2022; 62:361-368. [PMID: 35613881 PMCID: PMC9464478 DOI: 10.2176/jns-nmc.2022-0010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The use of robot-assisted frameless stereotactic electroencephalography (SEEG) is becoming more common. Among available robotic arms, Stealth Autoguide (SA) (Medtronic, Minneapolis, MN, USA) functions as an optional instrument of the neuronavigation system. The aims of this study were to present our primary experiences with SEEG using SA and to compare the accuracy of implantation between SA and navigation-guided manual adjustment (MA). Seventeen electrodes from two patients who underwent SEEG with SA and 18 electrodes from four patients with MA were retrospectively reviewed. We measured the distance between the planned location and the actual location at entry (De) and the target (Dt) in each electrode. The length of the trajectory did not show a strong correlation with Dt in SA (Pearson's correlation coefficient [r] = 0.099, p = 0.706) or MA (r = 0.233, p = 0.351). De and Dt in SA were shorter than those in MA (1.99 ± 0.90 vs 4.29 ± 1.92 mm, p = 0.0002; 3.59 ± 2.22 vs 5.12 ± 1.40 mm, p = 0.0065, respectively). SA offered higher accuracy than MA both at entry and target. Surgical times per electrode were 38.9 and 32 min in the two patients with SA and ranged from 51.6 to 88.5 min in the four patients with MA. During the implantation period of 10.3 ± 3.6 days, no patients experienced any complications.
Collapse
Affiliation(s)
- Yuichiro Kojima
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine
| | - Takehiro Uda
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine.,Department of Pediatric Neurosurgery, Osaka City General Hospital
| | - Toshiyuki Kawashima
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine
| | - Saya Koh
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine
| | - Masato Hattori
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine
| | - Yuki Mito
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine
| | | | - Shohei Ikeda
- Department of Pediatric Neurosurgery, Osaka City General Hospital
| | - Ryoko Umaba
- Department of Pediatric Neurosurgery, Osaka City General Hospital
| | - Takeo Goto
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine
| |
Collapse
|
6
|
Fujimoto A, Matsumaru Y, Masuda Y, Marushima A, Hosoo H, Araki K, Ishikawa E. Endovascular Electroencephalogram Records Simultaneous Subdural Electrode-Detectable, Scalp Electrode-Undetectable Interictal Epileptiform Discharges. Brain Sci 2022; 12:brainsci12030309. [PMID: 35326265 PMCID: PMC8946704 DOI: 10.3390/brainsci12030309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction: We hypothesized that an endovascular electroencephalogram (eEEG) can detect subdural electrode (SDE)-detectable, scalp EEG-undetectable epileptiform discharges. The purpose of this study is, therefore, to measure SDE-detectable, scalp EEG-undetectable epileptiform discharges by an eEEG on a pig. Methods: A pig under general anesthesia was utilized to measure an artificially generated epileptic field by an eEEG that was able to be detected by an SDE, but not a scalp EEG as a primary outcome. We also compared the phase lag of each epileptiform discharge that was detected by the eEEG and SDE as a secondary outcome. Results: The eEEG electrode detected 113 (97%) epileptiform discharges (97% sensitivity). Epileptiform discharges that were localized within the three contacts (contacts two, three and four), but not spread to other parts, were detected by the eEEG with a 92% sensitivity. The latency between peaks of the eEEG and right SDE earliest epileptiform discharge ranged from 0 to 48 ms (mean, 13.3 ms; median, 11 ms; standard deviation, 9.0 ms). Conclusion: In a pig, an eEEG could detect epileptiform discharges that an SDE could detect, but that a scalp EEG could not.
Collapse
Affiliation(s)
- Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka 988-056, Japan;
- School of Rehabilitation Sciences, Seirei Christopher University, Shizuoka 988-056, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
- E.P. Medical Inc., 403 Nihonbashi-Life-Science Building, 2-3-11, Honcho, Nihonbashi, Chuo-ku, Tokyo 103-0023, Japan
- Correspondence: ; Tel.: +81-29-853-3900; Fax: +81-29-853-3214
| | - Yosuke Masuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Hisayuki Hosoo
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Kota Araki
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| |
Collapse
|