Robotic-Guided Stereoelectroencephalography for Invasive Epilepsy Monitoring

作者： Efstathios D. Kondylis1,2, Akshay Sharma1,2, Nehaw Sarmey3, Stephen Harasimchuk1,2, Juan Bulacio1,4, Richard Rammo1,2, William Bingaman1,2,4, Demitre Serletis1,2,4 1Epilepsy Center, Neurological Institute,Cleveland Clinic, 2Department of Neurological Surgery, Neurological Institute,Cleveland Clinic, 3Department of Neurosurgery,University of Arizona, Tucson, 4Cleveland Clinic Lerner College of Medicine of Case Western Reserve University

简介：

Overview

This study presents a protocol for robot-assisted stereo electroencephalography (sEEG) used for the stereotactic implantation of intracerebral electrodes in patients with refractory epilepsy. The method enhances safety and precision in invasive seizure monitoring, potentially improving surgical efficiency, particularly when a larger number of electrodes are required.

Key Study Components

Area of Science

• Neurosurgery
• Epilepsy monitoring
• Robotic-assisted surgical techniques

Background

• Stereoelectroencephalography (sEEG) was developed to improve seizure monitoring.
• Robotic guidance overcomes challenges in electrode implantation.
• The method minimizes risks to surrounding brain structures and vessels.
• Proper planning and trajectory selection are vital for successful outcomes.

Purpose of Study

• To outline a method for precise implantation of intracerebral electrodes.
• To demonstrate the efficiency of robotic assistance in sEEG procedures.
• To emphasize the importance of careful trajectory planning in high-risk regions.

Methods Used

• Robot-assisted planning for electrode implantation in patients with refractory epilepsy.
• Electrode trajectories planned using imaging techniques and robotic interfaces.
• Involves pre-surgical mapping and the use of software for electrode placement.
• Proper entry points have been defined to avoid injury to vessels.
• Utilizes combined CT and MR imaging for accurate visualization of anatomical structures.

Main Results

• The robotic interface allows for the identification of safe trajectories for electrode placement.
• Sequential placement ensures minimal collision with brain vessels.
• Planning includes assessing various electrode placements for optimal data sampling from the target regions.
• Highlighted findings validate the efficacy of the planned trajectories in enhancing monitoring precision.

Conclusions

• This protocol demonstrates the benefits of robotic assistance in sEEG implantation.
• The approach simplifies complex planning and enhances electrode placement accuracy.
• Improved understanding of neuronal dynamics during seizures is facilitated by the detailed mapping enabled by this method.

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