Technique, Results, and Complications Related to Robot-Assisted Stereoelectroencephalography

• Published in: Neurosurgery Vol. 78; no. 2; pp. 169 - 180
• Main Authors: González-Martínez, Jorge, Bulacio, Juan, Thompson, Susan, Gale, John, Smithason, Saksith, Najm, Imad, Bingaman, William
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.02.2016; Copyright by the Congress of Neurological Surgeons; Wolters Kluwer Health, Inc
• Subjects: Adolescent; Adult; Brain - physiopathology; Brain - surgery; Brain Mapping - methods; Child; Child, Preschool; Convulsions & seizures; Electrodes; Electrodes, Implanted - adverse effects; Electroencephalography - adverse effects; Electroencephalography - methods; Female; Follow-Up Studies; Humans; Imaging, Three-Dimensional; Intraoperative Complications - diagnosis; Intraoperative Complications - etiology; Male; Middle Aged; Neurosurgery; Prospective Studies; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Robotics; Robots; Seizures - diagnosis; Seizures - physiopathology; Seizures - surgery; Stereotaxic Techniques - adverse effects; Young Adult; Robotic surgery; Stereo-electroencephalography; Seizure outcome; Epilepsy surgery; Complications; In vivo application accuracy
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0000000000001034

ABSTRACT BACKGROUND: Robot-assisted stereoelectroencephalography (SEEG) may represent a simplified, precise, and safe alternative to the more traditional SEEG techniques. OBJECTIVE: To report our clinical experience with robotic SEEG implantation and to define its utility in the management of patients with medically refractory epilepsy. METHODS: The prospective observational analyses included all patients with medically refractory focal epilepsy who underwent robot-assisted stereotactic placement of depth electrodes for extraoperative brain monitoring between November 2009 and May 2013. Technical nuances of the robotic implantation technique are presented, as well as an analysis of demographics, time of planning and procedure, seizure outcome, in vivo accuracy, and procedure-related complications. RESULTS: One hundred patients underwent 101 robot-assisted SEEG procedures. Their mean age was 33.2 years. In total, 1245 depth electrodes were implanted. On average, 12.5 electrodes were implanted per patient. The time of implantation planning was 30 minutes on average (range, 15-60 minutes). The average operative time was 130 minutes (range, 45-160 minutes). In vivo accuracy (calculated in 500 trajectories) demonstrated a median entry point error of 1.2 mm (interquartile range, 0.78-1.83 mm) and a median target point error of 1.7 mm (interquartile range, 1.20-2.30 mm). Of the group of patients who underwent resective surgery (68 patients), 45 (66.2%) gained seizure freedom status. Mean follow-up was 18 months. The total complication rate was 4%. CONCLUSION: The robotic SEEG technique and method were demonstrated to be safe, accurate, and efficient in anatomically defining the epileptogenic zone and subsequently promoting sustained seizure freedom status in patients with difficult-to-localize seizures.