Pediatric stereo-electroencephalography: effects of robot assistance and other variables on seizure outcome and complications

Abstract

OBJECTIVE The safety of stereo-electroencephalography (SEEG) has been investigated; however, most studies have not differentiated pediatric and adult populations, which have different anatomy and physiology. The purpose of this study was to assess SEEG safety in the pediatric setting, focusing on surgical complications and the identification of patient and surgical risk factors, if any. The authors also aimed to determine whether robot assistance in SEEG was associated with a change in practice, surgical parameters, and clinical outcomes. METHODS The authors retrospectively studied all SEEG cases performed in their department from December 2014 to March 2020. They analyzed both demographic and surgical variables and noted the types of surgery-related complications and their management. They also studied the clinical outcomes of a subset of the patients in relation to robot-assisted and non–robot-assisted SEEG. RESULTS Sixty-three children had undergone 64 SEEG procedures. Girls were on average 3 years younger than the boys (mean age 11.1 vs 14.1 years, p < 0.01). The overall complication rate was 6.3%, and the complication rate for patients with left-sided electrodes was higher than that for patients with right-sided electrodes (11.1% vs 3.3%), although the difference between the two groups was not statistically significant. The duration of recording was positively correlated to the number of implanted electrodes (r = 0.296, p < 0.05). Robot assistance was associated with a higher number of implanted electrodes (mean 12.6 vs 7.6 electrodes, p < 0.0001). Robot-assisted implantations were more accurate, with a mean error of 1.51 mm at the target compared to 2.98 mm in nonrobot implantations (p < 0.001). Clinical outcomes were assessed in the first 32 patients treated (16 in the nonrobot group and 16 in the robot group), 23 of whom proceeded to further resective surgery. The children who had undergone robot-assisted SEEG had better eventual seizure control following subsequent epilepsy surgery. Of the children who had undergone resective epilepsy surgery, 42% (5/12) in the nonrobot group and 82% (9/11) in the robot group obtained an Engel class IA outcome at 1 year (χ2 = 3.885, p = 0.049). Based on Kaplan-Meier survival analysis, the robot group had a higher seizure-free rate than the nonrobot group at 30 months postoperation (7/11 vs 2/12, p = 0.063). Two complications, whose causes were attributed to the implantation and head-bandaging steps, required surgical intervention. All complications were either transient or reversible. CONCLUSIONS This is the largest single-center, exclusively pediatric SEEG series that includes robot assistance so far. SEEG complications are uncommon and usually transient or treatable. Robot assistance enabled implantation of more electrodes and improved epilepsy surgery outcomes, as compared to those in the non–robot-assisted cases.

Recent advances in epilepsy surgery

“…The introduction of robotic assistance for intracranial monitoring has brought an enhanced profile for synchronously sampling epileptogenic networks within multiple regions, increasing the accuracy of diagnosis and SOZ delineation. Robotic-assisted placement of intracranial electrodes decreases the operating time, reduces brain entry error and has recently shown to increase surgical outcomes following resective surgery in a selected paediatric population [26]. Intracranial monitoring may even be of value in cases of lesional epilepsy, as a recent report found that up to 56% of MRI lesions partially overlap or may not overlap with the epileptogenic foci found on intracranial EEG [27].…”

Minimally Invasive Destructive, Ablative, and Disconnective Epilepsy Surgery

“…Modern stereotactic neurosurgery commonly uses surgical robots which have further improved accuracy and efficiency when compared with traditional frame-based methods. [37][38][39][40] Fig. 1 Intraoperative photo of an anatomical hemispherectomy for a patient with Rasmussen's syndrome.…”

“…Modern stereotactic neurosurgery commonly uses surgical robots which have further improved accuracy and efficiency when compared with traditional frame-based methods. 37 38 39 40…”

Subdural electrodes versus stereoelectroencephalography for pediatric epileptogenic zone localization: a retrospective cohort study

“…[5][6][7] The recent advances in neuroimaging, stereotactic targeting, and neurosurgical robotics have led to the increasing use of sEEG throughout North America and the world. [8][9][10][11][12] sEEG is an attractive alternative because it obviates the need to perform a craniotomy prior to localizing the EZ. 13 However, because there are no randomized controlled trials (RCTs) to compare SDE and sEEG invasive monitoring strategies, which of these techniques is 1) associated with fewer complications and 2) associ-ated with the highest success of seizure freedom remains unknown.…”