1
|
Du C, Wang L, Yan J, Li G, Wu Y, Zhao G, Cui D, Jin W, Yin S. The Association Between Trajectory-Skull Angle and Accuracy of Stereoelectroencephalography Electrode Implantation in Drug-Resistant Epilepsy. World Neurosurg 2024; 184:e408-e416. [PMID: 38309654 DOI: 10.1016/j.wneu.2024.01.139] [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: 07/26/2023] [Accepted: 01/24/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To analyze the relationship between trajectory-skull angle and stereoelectroencephalography electrode implantation accuracy in drug-resistant epilepsy patients, aiming to guide clinical electrode placement and enhance surgical precision and safety. METHODS We conducted a retrospective analysis of medical records and surgical characteristics of 32 consecutive patients diagnosed with drug-resistant epilepsy, who underwent stereoelectroencephalography procedures at our center from June 2020 to June 2023. To evaluate the accuracy of electrode implantation, we utilized preoperative and postoperative computed tomography scans fused with SinoPlan software-planned trajectories. Entry radial error and target vector error were assessed as measurements of electrode implantation accuracy. RESULTS After adjusting for confounders, we found a significant positive correlation between trajectory-skull angle and entry radial error (β = 0.02, 95% CI: 0.01-0.03, P < 0.001). Likewise, a significant positive correlation existed between trajectory-skull angle and target vector error in all three models (β = 0.03, 95% CI: 0.01-0.04, P < 0.001). Additionally, a U-shaped relationship between trajectory-skull angle and target vector error was identified using smooth curve fitting. This U-shaped pattern persisted in both frame-based and robot-guided stereotactic techniques. According to the two-piecewise linear regression model, the inflection points were 9° in the frame-based group and 16° in the robot-guided group. CONCLUSIONS This study establishes a significant positive linear correlation between trajectory-skull angle and entry radial error, along with a distinctive U-shaped pattern in the relationship between trajectory-skull angle and target vector error. Our findings suggest that trajectory-skull angles of 9° (frame-based) and 16° (robot-guided) may optimize the accuracy of target vector error.
Collapse
Affiliation(s)
- Chuan Du
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China; Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Le Wang
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, China
| | - Jingtao Yan
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Guangfeng Li
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Yuzhang Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Guangrui Zhao
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Deqiu Cui
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, China
| | - Weipeng Jin
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, China
| | - Shaoya Yin
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, China.
| |
Collapse
|
2
|
Niznik T, Grossen A, Shi H, Stephens M, Herren C, Desai VR. Learning Curve in Robotic Stereoelectroencephalography: Single Platform Experience. World Neurosurg 2024; 182:e442-e452. [PMID: 38030071 DOI: 10.1016/j.wneu.2023.11.119] [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: 06/16/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Learning curve, training, and cost impede widespread implementation of new technology. Neurosurgical robotic technology introduces challenges to visuospatial reasoning and requires the acquisition of new fine motor skills. Studies detailing operative workflow, learning curve, and patient outcomes are needed to describe the utility and cost-effectiveness of new robotic technology. METHODS A retrospective analysis was performed of pediatric patients who underwent robotic stereoelectroencephalography (sEEG) with the Medtronic Stealth Autoguide. Workflow, total operative time, and time per electrode were evaluated alongside target accuracy assessed via error measurements and root sum square. Patient demographics and clinical outcomes related to sEEG were also assessed. RESULTS Robot-assisted sEEG was performed in 12 pediatric patients. Comparison of cases over time demonstrated a mean operative time of 363.3 ± 109.5 minutes for the first 6 cases and 256.3 ± 59.1 minutes for the second 6 cases, with reduced operative time per electrode (P = 0.037). Mean entry point error, target point error, and depth point error were 1.82 ± 0.77 mm, 2.26 ± 0.71 mm, and 1.27 ± 0.53 mm, respectively, with mean root sum square of 3.23 ± 0.97 mm. Error measurements between magnetic resonance imaging and computed tomography angiography found computed tomography angiography to be more accurate with significant differences in mean entry point error (P = 0.043) and mean target point error (P = 0.035). The epileptogenic zone was identified in 11 patients, with therapeutic surgeries following in 9 patients, of whom 78% achieved an Engel class I. CONCLUSIONS This study demonstrated institutional workflow evolution and learning curve for the Autoguide in pediatric sEEG, resulting in reduced operative times and increased accuracy over a small number of cases. The platform may seamlessly and quickly be incorporated into clinical practice, and the provided workflow can facilitate a smooth transition.
Collapse
Affiliation(s)
- Taylor Niznik
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Audrey Grossen
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Helen Shi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Mark Stephens
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Cherie Herren
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Virendra R Desai
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA.
| |
Collapse
|
3
|
Winter F, Krueger MT, Delev D, Theys T, Van Roost DMP, Fountas K, Schijns OE, Roessler K. Current state of the art of traditional and minimal invasive epilepsy surgery approaches. BRAIN & SPINE 2024; 4:102755. [PMID: 38510599 PMCID: PMC10951767 DOI: 10.1016/j.bas.2024.102755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 03/22/2024]
Abstract
Introduction Open resective surgery remains the main treatment modality for refractory epilepsy, but is often considered a last resort option due to its invasiveness. Research question This manuscript aims to provide an overview on traditional as well as minimally invasive surgical approaches in modern state of the art epilepsy surgery. Materials and methods This narrative review addresses both historical and contemporary as well as minimal invasive surgical approaches in epilepsy surgery. Peer-reviewed published articles were retrieved from PubMed and Scopus. Only articles written in English were considered for this work. A range of traditional and minimally invasive surgical approaches in epilepsy surgery were examined, and their respective advantages and disadvantages have been summarized. Results The following approaches and techniques are discussed: minimally invasive diagnostics in epilepsy surgery, anterior temporal lobectomy, functional temporal lobectomy, selective amygdalohippocampectomy through a transsylvian, transcortical, or subtemporal approach, insulo-opercular corticectomies compared to laser interstitial thermal therapy, radiofrequency thermocoagulation, stereotactic radiosurgery, neuromodulation, high intensity focused ultrasound, and disconnection surgery including callosotomy, hemispherotomy, and subpial transections. Discussion and conclusion Understanding the benefits and disadvantages of different surgical approaches and strategies in traditional and minimal invasive epilepsy surgery might improve the surgical decision tree, as not all procedures are appropriate for all patients.
Collapse
Affiliation(s)
- Fabian Winter
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Marie T. Krueger
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
- Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Freiburg, Germany
| | - Daniel Delev
- Department of Neurosurgery, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Center for Integrated Oncology, Universities Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany
| | - Tom Theys
- Department of Neurosurgery, Universitair Ziekenhuis Leuven, UZ Leuven, Belgium
| | | | - Kostas Fountas
- Department of Neurosurgery, University of Thessaly, Greece
| | - Olaf E.M.G. Schijns
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience (MHeNS), University Maastricht, Maastricht, the Netherlands
- Academic Center for Epileptology, Maastricht University Medical Center & Kempenhaeghe, Maastricht, Heeze, the Netherlands
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Austria
| |
Collapse
|
4
|
Cameron N, Fry L, Kabangu JL, Schatmeyer BA, Miller C, Ulloa CM, Uysal U, Cheng JJ, Kinsman MJ, Rouse AG, Landazuri P. Using pre-surgical suspicion to guide insula implantation strategy. Heliyon 2023; 9:e18284. [PMID: 37539155 PMCID: PMC10395527 DOI: 10.1016/j.heliyon.2023.e18284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023] Open
Abstract
Rationale Insular epilepsy can be a challenging diagnosis due to overlapping semiology and scalp EEG findings with frontal, temporal, and parietal lobe epilepsies. Stereotactic electroencephalography (sEEG) provides an opportunity to better localize seizure onset. The possibility of improved localization is balanced by implantation risk in this vascularly rich anatomic region. We review both safety and pre-implantation factors involved in insular electrode placement across four years at an academic medical center. Methods Presurgical data, operative reports, and invasive EEG summaries were retrospectively reviewed for patients undergoing invasive epilepsy monitoring on the insula from 2016 through 2019. EEG reports were reviewed to record the presence of insula ictal and interictal involvement. We recorded which presurgical findings suggested insular involvement (insula lesion on MRI, insula changes on PET/SPECT/scalp EEG, characteristic semiology, or history of failed anterior temporal lobectomy). The likelihood of pre-sEEG insular onset was categorized as low suspicion if no presurgical findings were present ("rule out"), moderate suspicion if one finding was present, and high suspicion if two or more findings were present. Results 76 patients received 189 insular electrodes as part of their implantation strategy for 79 surgical cases. Seven patients (8.9%) had insular ictal onset. One clinically significant complication (left hemiparesis) occurred in a patient with moderate suspicion for insular onset. There were 38 low suspicion cases, 36 moderate suspicion cases, and 5 high suspicion cases for pre-sEEG insula ictal onset. Two low suspicion (5.3%), three moderate suspicion (8.6%), and two high suspicion (40%) cases had insular ictal onset. Conclusions The insula can safely receive sEEG. Having two or more presurgical factors indicating insular onset is a strong, albeit incomplete, predictor of insular seizure onset. Using pre-implantation clinical findings can offer clinicians predictive value for targeting the insula during invasive EEG monitoring.
Collapse
Affiliation(s)
- Nathaniel Cameron
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Lane Fry
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Jean-Luc Kabangu
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | | | - Christopher Miller
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Carol M. Ulloa
- Dept. of Neurology, University of Kansas Medical Center, United States
| | - Utku Uysal
- Dept. of Neurology, University of Kansas Medical Center, United States
| | - Jennifer J. Cheng
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Michael J. Kinsman
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Adam G. Rouse
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
- Dept. of Cell Biology & Physiology, University of Kansas Medical Center, United States
- Dept. of Electrical Engineering and Computer Science, University of Kansas, United States
| | - Patrick Landazuri
- Dept. of Neurology, University of Kansas Medical Center, United States
| |
Collapse
|
5
|
Solanki C, Williams J, Andrews C, Fayed I, Wu C. Insula in epilepsy - "untying the gordian knot": A systematic review. Seizure 2023; 106:148-161. [PMID: 36878050 DOI: 10.1016/j.seizure.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023] Open
Abstract
PURPOSE Despite significant advances in epileptology, there are still many uncertainties about the role of the insula in epilepsy. Until recently, most insular onset seizures were wrongly attributed to the temporal lobe. Further, there are no standardised approaches to the diagnosis and treatment of insular onset seizures. This systematic review gathers the available information about insular epilepsy and synthesizes current knowledge as a basis for future research. METHOD Adhering to the PRISMA guidelines, studies were meticulously extracted from the PubMed database. The empirical data pertaining to the semiology of insular seizures, insular networks in epilepsy, techniques of mapping the insula, and the surgical intricacies of non-lesional insular epilepsy were reviewed from published studies. The corpus of information available was then subjected to a process of concise summarization and astute synthesis. RESULTS Out of 235 studies identified for full-text review, 86 studies were included in the systematic review. The insula emerges as a brain region with a number of functional subdivisions. The semiology of insular seizures is diverse and depends on the involvement of particular subdivisions. The semiological heterogeneity of insular seizures is explained by the extensive connectivity of the insula and its subdivisions with all four lobes of the brain, deep grey matter structures, and remote brainstem areas. The mainstay of the diagnosis of seizure onset in the insula is stereoelectroencephalography (SEEG). The surgical resection of the insular epileptogenic zone (when possible) is the most effective treatment. Open surgery on the insula is challenging but magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) also holds promise. CONCLUSION The physiological and functional roles of the insula in epilepsy have remained obfuscated. The dearth of precisely defined diagnostic and therapeutic protocols acts as an impediment to scientific advancement. This review could potentially facilitate forthcoming research endeavours by establishing a foundational framework for uniform data collection protocols, thereby enhancing the feasibility of comparing findings across future studies and promoting progress in this domain.
Collapse
Affiliation(s)
- Chirag Solanki
- Consultant Neurosurgeon, Department of Neurosurgery, Sterling Hospital, Ahmedabad, Gujarat, India.
| | - Justin Williams
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, United States.
| | - Carrie Andrews
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, United States.
| | - Islam Fayed
- Stereotactic and Functional Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, United States.
| | - Chengyuan Wu
- Associate Professor of Neurosurgery and Radiology, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, United States.
| |
Collapse
|
6
|
Dai Y, Zhang H, Fan X, Wei P, Shan Y, Zhao G. Optimized SEEG-guided three-dimensional radiofrequency thermocoagulation for insular epilepsy. Acta Neurochir (Wien) 2023; 165:249-258. [PMID: 36342542 DOI: 10.1007/s00701-022-05401-9] [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: 07/28/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE The high risk of resection surgery for drug-resistant insular epilepsy has driven interest in new treatment techniques. Stereo-electroencephalography-guided three-dimensional radiofrequency thermocoagulation (SEEG-3D RFTC) offers an alternative option. Herein, we present the detailed protocol and investigation of the efficacy and safety of a preliminary observational study. METHODS From February 2017 to April 2021, ten patients diagnosed with insular epilepsy were enrolled in the study. They underwent implantation of a combination of SEEG electrodes to form a high-density focal stereo-array in insula, including oblique electrodes through the long axis of insula and orthogonal electrodes to widely cover the medial and lateral insula. SEEG-3D RFTC was performed between two contiguous contacts of the same electrode, or between two adjacent contacts of different electrodes. RESULTS Surgical procedures were well tolerated, with no related long-term complications. Seizure-free outcome was achieved in seven patients (70%), including ILAE I in four and ILAE II in three. Two other (20%) patients had rare seizures (ILAE III). One (10%) patient experienced an ILAE IV outcome (follow-up = 12--63 months). The responder rate (including ILAE I-IV) was 100%. CONCLUSION The optimized SEEG-3D RFTC is an effective and safe option for the treatment of drug-resistant insular epilepsy.
Collapse
Affiliation(s)
- Yang Dai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St., Xicheng District, Beijing, 100053, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, 100053, China
| | - Huaqiang Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St., Xicheng District, Beijing, 100053, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, 100053, China
| | - Xiaotong Fan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St., Xicheng District, Beijing, 100053, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, 100053, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St., Xicheng District, Beijing, 100053, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, 100053, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St., Xicheng District, Beijing, 100053, China.
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, 100053, China.
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St., Xicheng District, Beijing, 100053, China.
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, 100053, China.
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.
| |
Collapse
|
7
|
Sui Y, Yu H, Zhang C, Chen Y, Jiang C, Li L. Deep brain-machine interfaces: sensing and modulating the human deep brain. Natl Sci Rev 2022; 9:nwac212. [PMID: 36644311 PMCID: PMC9834907 DOI: 10.1093/nsr/nwac212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/02/2022] [Accepted: 10/04/2022] [Indexed: 01/18/2023] Open
Abstract
Different from conventional brain-machine interfaces that focus more on decoding the cerebral cortex, deep brain-machine interfaces enable interactions between external machines and deep brain structures. They sense and modulate deep brain neural activities, aiming at function restoration, device control and therapeutic improvements. In this article, we provide an overview of multiple deep brain recording and stimulation techniques that can serve as deep brain-machine interfaces. We highlight two widely used interface technologies, namely deep brain stimulation and stereotactic electroencephalography, for technical trends, clinical applications and brain connectivity research. We discuss the potential to develop closed-loop deep brain-machine interfaces and achieve more effective and applicable systems for the treatment of neurological and psychiatric disorders.
Collapse
Affiliation(s)
- Yanan Sui
- National Engineering Research Center of Neuromodulation, Tsinghua University, Beijing 100084, China
| | - Huiling Yu
- National Engineering Research Center of Neuromodulation, Tsinghua University, Beijing 100084, China
| | - Chen Zhang
- National Engineering Research Center of Neuromodulation, Tsinghua University, Beijing 100084, China
| | - Yue Chen
- National Engineering Research Center of Neuromodulation, Tsinghua University, Beijing 100084, China
| | - Changqing Jiang
- National Engineering Research Center of Neuromodulation, Tsinghua University, Beijing 100084, China
| | | |
Collapse
|
8
|
Rahman RK, Tomlinson SB, Katz J, Galligan K, Madsen PJ, Tucker AM, Kessler SK, Kennedy BC. Stereoelectroencephalography before 2 years of age. Neurosurg Focus 2022; 53:E3. [DOI: 10.3171/2022.7.focus22336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE
Stereoelectroencephalography (SEEG) is a widely used technique for localizing seizure onset zones prior to resection. However, its use has traditionally been avoided in children under 2 years of age because of concerns regarding pin fixation in the immature skull, intraoperative and postoperative electrode bolt security, and stereotactic registration accuracy. In this retrospective study, the authors describe their experience using SEEG in patients younger than 2 years of age, with a focus on the procedure’s safety, feasibility, and accuracy as well as surgical outcomes.
METHODS
A retrospective review of children under 2 years of age who had undergone SEEG while at Children’s Hospital of Philadelphia between November 2017 and July 2021 was performed. Data on clinical characteristics, surgical procedure, imaging results, electrode accuracy measurements, and postoperative outcomes were examined.
RESULTS
Five patients younger than 2 years of age underwent SEEG during the study period (median age 20 months, range 17–23 months). The mean age at seizure onset was 9 months. Developmental delay was present in all patients, and epilepsy-associated genetic diagnoses included tuberous sclerosis (n = 1), KAT6B (n = 1), and NPRL3 (n = 1). Cortical lesions included tubers from tuberous sclerosis (n = 1), mesial temporal sclerosis (n = 1), and cortical dysplasia (n = 3). The mean number of placed electrodes was 11 (range 6–20 electrodes). Bilateral electrodes were placed in 1 patient. Seizure onset zones were identified in all cases. There were no SEEG-related complications, including skull fracture, electrode misplacement, hemorrhage, infection, cerebrospinal fluid leakage, electrode pullout, neurological deficit, or death. The mean target point error for all electrodes was 1.0 mm. All patients proceeded to resective surgery, with a mean follow-up of 21 months (range 8–53 months). All patients attained a favorable epilepsy outcome, including Engel class IA (n = 2), IC (n = 1), ID (n = 1), and IIA (n = 1).
CONCLUSIONS
SEEG can be safely, accurately, and effectively utilized in children under age 2 with good postoperative outcomes using standard SEEG equipment. With minimal modification, this procedure is feasible in those with immature skulls and guides the epilepsy team’s decision-making for early and optimal treatment of refractory epilepsy through effective localization of seizure onset zones.
Collapse
Affiliation(s)
- Raphia K. Rahman
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Samuel B. Tomlinson
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua Katz
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kathleen Galligan
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania
| | - Peter J. Madsen
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander M. Tucker
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sudha Kilaru Kessler
- Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania; and
- Departments of Pediatrics and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin C. Kennedy
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
9
|
DeLorey C, Davids JD, Cartucho J, Xu C, Roddan A, Nimer A, Ashrafian H, Darzi A, Thompson AJ, Akhond S, Runciman M, Mylonas G, Giannarou S, Avery J. A c
able‐driven
soft robotic end‐effector actuator for probe‐based confocal laser endomicroscopy: Development and preclinical validation. TRANSLATIONAL BIOPHOTONICS 2022. [DOI: 10.1002/tbio.202200015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Charles DeLorey
- Institute of Global Health Innovation and the Hamlyn Centre for Robotic Surgery, Imperial College London London UK
| | - Joseph D. Davids
- Institute of Global Health Innovation and the Hamlyn Centre for Robotic Surgery, Imperial College London London UK
- National Hospital for Neurology and Neurosurgery London UK
| | - Joao Cartucho
- Institute of Global Health Innovation and the Hamlyn Centre for Robotic Surgery, Imperial College London London UK
| | - Chi Xu
- Institute of Global Health Innovation and the Hamlyn Centre for Robotic Surgery, Imperial College London London UK
| | - Alfie Roddan
- Institute of Global Health Innovation and the Hamlyn Centre for Robotic Surgery, Imperial College London London UK
| | - Amr Nimer
- UKRI Centre for AI in Healthcare Imperial College London London UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation and the Hamlyn Centre for Robotic Surgery, Imperial College London London UK
| | - Ara Darzi
- Institute of Global Health Innovation and the Hamlyn Centre for Robotic Surgery, Imperial College London London UK
| | - Alex James Thompson
- Institute of Global Health Innovation and the Hamlyn Centre for Robotic Surgery, Imperial College London London UK
| | - Saina Akhond
- Institute of Global Health Innovation and the Hamlyn Centre for Robotic Surgery, Imperial College London London UK
| | - Mark Runciman
- Institute of Global Health Innovation and the Hamlyn Centre for Robotic Surgery, Imperial College London London UK
| | - George Mylonas
- Institute of Global Health Innovation and the Hamlyn Centre for Robotic Surgery, Imperial College London London UK
| | - Stamatia Giannarou
- Institute of Global Health Innovation and the Hamlyn Centre for Robotic Surgery, Imperial College London London UK
| | - James Avery
- Institute of Global Health Innovation and the Hamlyn Centre for Robotic Surgery, Imperial College London London UK
| |
Collapse
|
10
|
Paredes-Aragon E, AlKhaldi NA, Ballesteros-Herrera D, Mirsattari SM. Stereo-Encephalographic Presurgical Evaluation of Temporal Lobe Epilepsy: An Evolving Science. Front Neurol 2022; 13:867458. [PMID: 35720095 PMCID: PMC9197919 DOI: 10.3389/fneur.2022.867458] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Drug-resistant epilepsy is present in nearly 30% of patients. Resection of the epileptogenic zone has been found to be the most effective in achieving seizure freedom. The study of temporal lobe epilepsy for surgical treatment is extensive and complex. It involves a multidisciplinary team in decision-making with initial non-invasive studies (Phase I), providing 70% of the required information to elaborate a hypothesis and treatment plans. Select cases present more complexity involving bilateral clinical or electrographic manifestations, have contradicting information, or may involve deeper structures as a part of the epileptogenic zone. These cases are discussed by a multidisciplinary team of experts with a hypothesis for invasive methods of study. Subdural electrodes were once the mainstay of invasive presurgical evaluation and in later years most Comprehensive Epilepsy Centers have shifted to intracranial recordings. The intracranial recording follows original concepts since its development by Bancaud and Talairach, but great advances have been made in the field. Stereo-electroencephalography is a growing field of study, treatment, and establishment of seizure pattern complexities. In this comprehensive review, we explore the indications, usefulness, discoveries in interictal and ictal findings, pitfalls, and advances in the science of presurgical stereo-encephalography for temporal lobe epilepsy.
Collapse
Affiliation(s)
- Elma Paredes-Aragon
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Norah A AlKhaldi
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada.,Neurology Department, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Daniel Ballesteros-Herrera
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suárez", Mexico City, Mexico
| | - Seyed M Mirsattari
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada.,Departments of Clinical Neurological Sciences, Diagnostic Imaging, Biomedical Imaging and Psychology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| |
Collapse
|
11
|
Zhang D, Cui X, Zheng J, Zhang S, Wang M, Lu W, Sang L, Li W. Neurosurgical robot-assistant stereoelectroencephalography system: Operability and accuracy. Brain Behav 2021; 11:e2347. [PMID: 34520631 PMCID: PMC8553331 DOI: 10.1002/brb3.2347] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/18/2021] [Accepted: 08/18/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Fine operation has been an eternal topic in neurosurgery. There were many problems in functional neurosurgery field with high precision requirements. Our study aims to explore the operability, accuracy and postoperative effect of robot-assisted stereoelectroencephalography (SEEG) in neurosurgery. METHODS We conducted a retrospective analysis of patients with epilepsy who underwent electrode implantation in our hospital. From 2016 to 2019, the epilepsy center of Hebei people's hospital implanted electrodes in neurosurgery on 24 patients, including 20 with SINO robot-assisted SEEG system and eight with frame-SEEG technology. RESULT Robot-assisted SEEG neurosurgery had higher accuracy, and the mean error of entry and target point was smaller than that of frame SEEG surgery. No bleeding or infection occurred postoperatively, and two patients who underwent robot-assisted SEEG neurosurgery had electrode displacement. Electrode displacement was observed in two patients, both the entry points were orbital frontal, one in the frame system and one in the robot assistant system. The average placement time of each electrode in robot assisted system surgery was less than that in frame system surgery. CONCLUSION The SINO SEEG electrode implantation assisted by surgical robot-assistant system manufactured in China is safe, accurate and mature.
Collapse
Affiliation(s)
- Di Zhang
- Neurosurgery Department of Epilepsy, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xuehua Cui
- Neurosurgery Department of Epilepsy, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jie Zheng
- Neurosurgery Department of Epilepsy, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shunyao Zhang
- Neurosurgery Department of Epilepsy, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Meng Wang
- Neurosurgery Department of Epilepsy, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenpeng Lu
- Neurosurgery Department of Epilepsy, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Linxia Sang
- Neurosurgery Department of Epilepsy, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenling Li
- Neurosurgery Department of Epilepsy, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
12
|
Machetanz K, Grimm F, Wang S, Bender B, Tatagiba M, Gharabaghi A, Naros G. Patient-to-robot registration: The fate of robot-assisted stereotaxy. Int J Med Robot 2021; 17:e2288. [PMID: 34036749 DOI: 10.1002/rcs.2288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/22/2021] [Accepted: 05/22/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Robot-assisted stereotaxy (RAS) promises higher stereotactic accuracy (SA) and time efficiency (TE) than frame-based stereotaxy. However, both aspects are attributed to the problem of patient-to-robot registration. OBJECTIVE To examine different registration techniques regarding their SA and TE. METHODS This study enrolled 57 patients undergoing RAS with bone fiducial registration (BFR) or laser surface registration (LSR). SA was measured by the entry point error (EPE). Additionally, predictors of SA (registration error [RegE], distance-to-registration plane [DTC]) and TE (imaging, skin-to-skin) were assessed. RESULTS The mean SA was 1.0 ± 0.8 mm. BFR increased SA by reducing RegE and DTC. In LSR, EPE depended on DTC (face and forehead) with highest accuracy for DTC ≤100 mm. CT-based LSR exerted a higher SA than MR-based LSR. In BFR, TE was confined by the additional imaging. CONCLUSION Every registration technique counteracts one of the promises of RAS. New solutions are needed to increase the acceptance of RAS in neurosurgery.
Collapse
Affiliation(s)
- Kathrin Machetanz
- Department of Neurosurgery and Neurotechnology, Neurosurgical Clinic, Eberhard Karls University, Tuebingen, Germany.,Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Florian Grimm
- Department of Neurosurgery and Neurotechnology, Neurosurgical Clinic, Eberhard Karls University, Tuebingen, Germany.,Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Sophie Wang
- Department of Neurosurgery and Neurotechnology, Neurosurgical Clinic, Eberhard Karls University, Tuebingen, Germany
| | - Benjamin Bender
- Department of Neuroradiology, Eberhard Karls University, Tuebingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery and Neurotechnology, Neurosurgical Clinic, Eberhard Karls University, Tuebingen, Germany
| | - Alireza Gharabaghi
- Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Georgios Naros
- Department of Neurosurgery and Neurotechnology, Neurosurgical Clinic, Eberhard Karls University, Tuebingen, Germany.,Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| |
Collapse
|
13
|
Machetanz K, Grimm F, Wuttke TV, Kegele J, Lerche H, Tatagiba M, Rona S, Gharabaghi A, Honegger J, Naros G. Frame-based and robot-assisted insular stereo-electroencephalography via an anterior or posterior oblique approach. J Neurosurg 2021; 135:1477-1486. [PMID: 33930861 DOI: 10.3171/2020.10.jns201843] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is an increasing interest in stereo-electroencephalography (SEEG) for invasive evaluation of insular epilepsy. The implantation of insular SEEG electrodes, however, is still challenging due to the anatomical location and complex functional segmentation in both an anteroposterior and ventrodorsal (i.e., superoinferior) direction. While the orthogonal approach (OA) is the shortest trajectory to the insula, it might insufficiently cover these networks. In contrast, the anterior approach (AOA) or posterior oblique approach (POA) has the potential for full insular coverage, with fewer electrodes bearing a risk of being more inaccurate due to the longer trajectory. Here, the authors evaluated the implantation accuracy and the detection of epilepsy-related SEEG activity with AOA and POA insular trajectories. METHODS This retrospective study evaluated the accuracy of 220 SEEG electrodes in 27 patients. Twelve patients underwent a stereotactic frame-based procedure (frame group), and 15 patients underwent a frameless robot-assisted surgery (robot group). In total, 55 insular electrodes were implanted using the AOA or POA considering the insular anteroposterior and ventrodorsal functional organization. The entry point error (EPE) and target point error (TPE) were related to the implantation technique (frame vs robot), the length of the trajectory, and the location of the target (insular vs noninsular). Finally, the spatial distribution of epilepsy-related SEEG activity within the insula is described. RESULTS There were no significant differences in EPE (mean 0.9 ± 0.6 for the nonsinsular electrodes and 1.1 ± 0.7 mm for the insular electrodes) and TPE (1.5 ± 0.8 and 1.6 ± 0.9 mm, respectively), although the length of trajectories differed significantly (34.1 ± 10.9 and 70.1 ± 9.0 mm, repsectively). There was a significantly larger EPE in the frame group than in the robot group (1.5 ± 0.6 vs 0.7 ± 0.5 mm). However, there was no group difference in the TPE (1.5 ± 0.8 vs 1.6 ± 0.8 mm). Epilepsy-related SEEG activity was detected in 42% (23/55) of the insular electrodes. Spatial distribution of this activity showed a clustering in both anteroposterior and ventrodorsal directions. In purely insular onset cases, subsequent insular lesionectomy resulted in a good seizure outcome. CONCLUSIONS The implantation of insular electrodes via the AOA or POA is safe and efficient for SEEG implantation covering both anteroposterior and ventrodorsal functional organization with few electrodes. In this series, there was no decrease in accuracy due to the longer trajectory of insular SEEG electrodes in comparison with noninsular SEEG electrodes. The results of frame-based and robot-assisted implantations were comparable.
Collapse
Affiliation(s)
- Kathrin Machetanz
- 1Department of Neurosurgery
- 2Division of Functional and Restorative Neurosurgery, Department of Neurosurgery; and
| | - Florian Grimm
- 1Department of Neurosurgery
- 2Division of Functional and Restorative Neurosurgery, Department of Neurosurgery; and
| | - Thomas V Wuttke
- 1Department of Neurosurgery
- 3Department of Epileptology, Eberhardt Karls University, Tuebingen, Germany
| | - Josua Kegele
- 3Department of Epileptology, Eberhardt Karls University, Tuebingen, Germany
| | - Holger Lerche
- 3Department of Epileptology, Eberhardt Karls University, Tuebingen, Germany
| | | | | | - Alireza Gharabaghi
- 1Department of Neurosurgery
- 2Division of Functional and Restorative Neurosurgery, Department of Neurosurgery; and
| | | | - Georgios Naros
- 1Department of Neurosurgery
- 2Division of Functional and Restorative Neurosurgery, Department of Neurosurgery; and
| |
Collapse
|