Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results

Tay, Angelique Sao-Mai S; Menaker, Simon; Chan, Julie L.; Mamelak, Adam N.

doi:10.1227/ons.0000000000000110

Cited by 10 publications

(6 citation statements)

References 20 publications

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confidence: 62%

In Reply: Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results

Mamelak¹

2022

Operative Neurosurgery

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To the Editor:We appreciate the letter from Dr Philipp 1 in response to our article "Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results." 2 The authors are critical of our results, indicating that they do not support our conclusions. Rather, they suggest that the Autoguide system is both unsafe and inaccurate. We respectfully disagree.Our article was written as a technical report, describing a new method, and the early modifications that we adopted. It represents our initial learning curve. This is by no means an authoritative clinical series. Despite this, Philipp et al 3 compared our findings to several large series. These are simply not valid comparisons. They compare our results with those of Cardinale which included 500 patients. They also reference a report by Miller et al 4 of 152 patients using a standardized method and a meta-analysis with 2624 patients. 5 Comparison of these large series with a technical report of 9 patients during an initial period of learning is simply not justifiable.Furthermore, their entire safety concern is based on a single hemorrhage in the first patient implanted, a case in which we acknowledge the drilling method recommended by the manufacturer was problematic. Had we chosen to exclude the first patient and only report on the subsequent 8, and we would have missed the opportunity to point out this important technical issue to other users. Rather, we would have reported a 0% complication rate, seemingly indicating that the system is the safest one every reported in the literature! This would be equally ludicrous. This is the danger of statistical inference in low sample sizes. Based on their previous publications, 6 Philipp et al should be well aware of this danger. The goal of this article was to provide technical guidance for other users to increase their accuracy and reduce rates of complications. Any other reading of this article is incorrect.Furthermore, it is likely that true stereotactic electroencephalograhy hemorrhage rates are grossly underreported. By example, the Cleveland Clinic group (included as part of the analysis reported here as proof of our low safety 5 ) has reported a per the electrode complication rate of 0.18%, and only 3 patients having any sort of hemorrhage at 2.4%. 7 However, a blinded review of their own hemorrhagic complications in 549 consecutive patients noted a true hemorrhage rate of 19.1%, of which 2 (2%) were symptomatic and a death rate of 0.2%. 8 In other words, the exact same group, looking at their own data in 2 different ways, reported a hemorrhage rate that changed from 2.4% to 19%. This does not imply that the authors are dishonest.

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In Reply: Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results

Mamelak¹

2022

Operative Neurosurgery

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“…Fully automated systems continue to be the gold standard for placement of depth electrodes, deep brain stimulation, and other highly location-based neurosurgical treatments, although some groups are challenging this paradigm. [14][15][16] In this study, we sought to describe the surgical experience with the Autoguide over a consecutive series of patients.…”

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confidence: 99%

“…Although we did not assess this in the current study, the minimally invasive access parameters of this robotic system could be applied to performing awake biopsy procedures and have been successfully applied to both laser interstitial thermal therapy 16 and electroencephalography lead placement. 14,15 Use of the robotic system for cranial lesion biopsy was highly efficient. The median total operative time was short, at 55.0 minutes, even accounting for frozen pathology results to be sent back to the OR and the addition of secondary procedures such as VP shunt placement.…”

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confidence: 99%

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Surgical Characteristics of Intracranial Biopsy Using a Frameless Stereotactic Robotic Platform: A Single-Center Experience

Kreatsoulas,

Vignolles-Jeong,

Ambreen

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Cranial robotics are a burgeoning field of neurosurgery. To date, all cranial robotic systems described have been computerized, arm-based instruments that take up significant space in the operating room. The Medtronic Stealth Autoguide robot has a smaller operating room footprint and offers multiaxial, frame-based surgical targeting. The authors set out to define the surgical characteristics of a novel robotic platform for brain biopsy in a large patient cohort. METHODS: Patients who underwent stereotactic biopsy using the Stealth Autoguide cranial robotic platform from July 2020 to March 2023 were included in this study. Clinical, surgical, and histological data were collected and analyzed. RESULTS: Ninety-six consecutive patients (50 female, 46 male) were included. The mean age at biopsy was 53.7 ± 18.0 years. The mean target depth was 68.2 ± 15.3 mm. The biopsy diagnostic tissue acquisition rate was 100%. The mean time from incision to biopsy tissue acquisition was 15.4 ± 9.9 minutes. Target lesions were located throughout the brain: in the frontal lobe (n = 32, 33.3%), parietal lobe (n = 21, 21.9%), temporal lobe (n = 22, 22.9%), deep brain nuclei/thalamus (n = 13, 13.5%), cerebellum (n = 7, 7.3%), and brainstem (n = 1, 1.0%). Most cases were gliomas (n = 75, 78.2%). Patients were discharged home on postoperative day 0 or 1 in 62.5% of cases. A total of 7 patients developed postoperative complications (7.2%). CONCLUSION: This cranial robotic platform can be used for efficient, safe, and accurate cranial biopsies that allow for reliable diagnosis of intracranial pathology in a minimally invasive setting.

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“…The referenced article by Tay et al 1 describes a technique for implantation of depth electrodes for stereoelectroencephalography (sEEG) using the Stealth Autoguide system (Medtronic). This approach is a frameless technique, which uses a robotic arm for assisted placement of electrodes.…”

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Letter: Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results

Philipp

Miller

2022

Operative Neurosurgery

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Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results

Cited by 10 publications

References 20 publications

In Reply: Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results

In Reply: Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results

Surgical Characteristics of Intracranial Biopsy Using a Frameless Stereotactic Robotic Platform: A Single-Center Experience

Letter: Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results

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