Frameless robot-assisted stereoelectroencephalography for refractory epilepsy in pediatric patients: accuracy, usefulness, and technical issues

Candela, Santiago; Aparicio, Javier Romano; López, J. Muchart; Baños-Carrasco, Pilar; Ramírez‐Camacho, Alia; Climent, Alejandra; Alamar, Mariana; Jou, Cristina; Rumià, Jordi; Antonio‐Arce, Victoria San; Arzimanoglou, Alexis; Ferrer, Enrique

doi:10.1007/s00701-018-3720-8

Cited by 24 publications

(29 citation statements)

References 41 publications

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“…In Milan, Cardinale et al ( 38 ) used the Neuromate® dedicated fiducial markers (Neurolocate) developed by Renishaw (Mayfield, Nyon, Switzerland) and mounted on the robot arm, rendering the use of bone or skin fiducial markers unnecessary with a gain of time and simplicity. Neuromate® offers another possibility of referencing based on ultrasound registration and is used by other teams ( 39 ) ( Figure 2 ).…”

Section: Indications For Insular Seegmentioning

confidence: 99%

Indications, Techniques, and Outcomes of Robot-Assisted Insular Stereo-Electro-Encephalography: A Review

et al. 2020

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Stereo-electro-encephalography (SEEG) is an invasive, surgical, and electrophysiological method for three-dimensional registration and mapping of seizure activity in drug-resistant epilepsy. It allows the accurate analysis of spatio-temporal seizure activity by multiple intraparenchymal depth electrodes. The technique requires rigorous non-invasive pre-SEEG evaluation (clinical, video-EEG, and neuroimaging investigations) in order to plan the insertion of the SEEG electrodes with minimal risk and maximal recording accuracy. The resulting recordings are used to precisely define the surgical limits of resection of the epileptogenic zone in relation to adjacent eloquent structures. Since the initial description of the technique by Talairach and Bancaud in the 1950's, several techniques of electrode insertion have been used with accuracy and relatively few complications. In the last decade, robot-assisted surgery has emerged as a safe, accurate, and time-saving electrode insertion technique due to its unparalleled potential for orthogonal and oblique insertion trajectories, guided by rigorous computer-assisted planning. SEEG exploration of the insular cortex remains difficult due to its anatomical location, hidden by the temporal and frontoparietal opercula. Furthermore, the close vicinity of Sylvian vessels makes surgical electrode insertion challenging. Some epilepsy surgery teams remain cautious about insular exploration due to the potential of neurovascular injury. However, several authors have published encouraging results regarding the technique's accuracy and safety in both children and adults. We will review the indications, techniques, and outcomes of insular SEEG exploration with emphasis on robot-assisted implantation.

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Section: Indications For Insular Seegmentioning

confidence: 99%

Indications, Techniques, and Outcomes of Robot-Assisted Insular Stereo-Electro-Encephalography: A Review

et al. 2020

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“…The implantation errors were characterized through the differences among planned and actual target and entry points of the electrodes [10]. Electrode locations were automatically detected using the SEEG electroDE rEconstruction TOol (DEETO) software package [25] and verified visually.…”

Section: Case Reportmentioning

confidence: 99%

“…3a). LEPLE and LTPLE represent the distance from the actual entry or target point to the planned trajectory axis, TPLE is the Euclidean distance between the planned target point and the electrode’s tip, and TDE is defined as the difference between the planned target point and the electrode’s tip projection on the electrode axis, as used in similar studies [8-10, 22].…”

Section: Case Reportmentioning

confidence: 99%

“…Electrode placement accuracy is required for reaching the intended targets, as well as avoiding anatomical and vascular conflicts. The accuracy of the procedure was estimated by the difference between the planned entry and target coordinates and the accomplished ones [8-10]. A high accuracy reduces the chances of intracranial bleeding and ensures the correct exploration of cortical tissue, in line with the hypothesis of the EZ [6, 9-12].…”

Section: Introductionmentioning

confidence: 99%

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Accuracy and Safety of Customized Stereotactic Fixtures for Stereoelectroencephalography in Pediatric Patients

Pistol

Daneasa

Ciurea

et al. 2020

Stereotact Funct Neurosurg

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Stereoelectroencephalography (SEEG) in children with intractable epilepsy presents particular challenges. Their thin and partially ossified cranium, specifically in the temporal area, is prone to fracture while attaching stereotactic systems to the head or stabilizing the head in robot’s field of action. Postponing SEEG in this special population of patients can have serious consequences, reducing their chances of becoming seizure-free and impacting their social and cognitive development. This study demonstrates the safety and accuracy offered by a frameless personalized 3D printed stereotactic implantation system for SEEG investigations in children under 4 years of age. SEEG was carried out in a 3-year-old patient with drug-resistant focal epilepsy, based on a right temporal-perisylvian epileptogenic zone hypothesis. Fifteen intracerebral electrodes were placed using a StarFix patient-customized stereotactic fixture. The median lateral entry point localization error of the electrodes was 0.90 mm, median lateral target point localization error was 1.86 mm, median target depth error was 0.83 mm, and median target point localization error was 1.96 mm. There were no perioperative complications. SEEG data led to a tailored right temporal-insular-opercular resection, with resulting seizure freedom (Engel IA). In conclusion, patient-customized stereotactic fixtures are a safe and accurate option for SEEG exploration in young children.

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“…A recent meta-analysis [92] found that the combined accuracy of frame-based systems (EP error, 1.43 mm; 95% confidence interval [CI], 1.35–1.51; TP error, 1.93; 95% CI, 1.05–2.81) compared favorably to frameless systems (EP error, 2.45; 95% CI, 0.39–4.51; TP error, 2.89; 95% CI, 2.34–3.44). However, localization errors <2 mm have been reported using frameless and robot-assisted techniques in both pediatric and adult populations [11,12,28,41].…”

Section: Safety Accuracy and Efficacymentioning

confidence: 99%

Stereoelectroencephalography in Pediatric Epilepsy Surgery

Tomlinson

Buch

Armstrong

et al. 2019

J Korean Neurosurg Soc

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Stereoelectroencephalography (SEEG) is an invasive technique used during the surgical management of medically refractory epilepsy. The utility of SEEG rests in its ability to survey the three-dimensional organization of the epileptogenic zone as well as nearby eloquent cortices. Once concentrated to specialized centers in Europe and Canada, the SEEG methodology has gained worldwide popularity due to its favorable morbidity profile, superior coverage of deep structures, and ability to perform multilobar explorations without the need for craniotomy. This rapid shift in practice represents both a challenge and an opportunity for pediatric neurosurgeons familiar with the subdural grid approach. The purpose of this review is to discuss the indications, technique, and safety of long-term SEEG monitoring in children. In addition to reviewing the conceptual and technical points of the diagnostic evaluation, attention will also be given to SEEG-based interventions (e.g., radiofrequency thermo-coagulation).

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Frameless robot-assisted stereoelectroencephalography for refractory epilepsy in pediatric patients: accuracy, usefulness, and technical issues

Cited by 24 publications

References 41 publications

Indications, Techniques, and Outcomes of Robot-Assisted Insular Stereo-Electro-Encephalography: A Review

Indications, Techniques, and Outcomes of Robot-Assisted Insular Stereo-Electro-Encephalography: A Review

Accuracy and Safety of Customized Stereotactic Fixtures for Stereoelectroencephalography in Pediatric Patients

Stereoelectroencephalography in Pediatric Epilepsy Surgery

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