Robot-assisted vs. manually guided stereoelectroencephalography for refractory epilepsy: a systematic review and meta-analysis

Gomes, Fernando Cotrim; Larcipretti, Anna Laura Lima; Nager, Gabriela Borges; Dagostin, Caroline Serafim; Udoma-Udofa, Ofonime Chantal; Pontes, Julia Pereira Muniz; Oliveira, Jéssica Sales de; Souza, Justine Hellen Cavalcanti de; Bannach, Matheus de Andrade

doi:10.1007/s10143-023-01992-8

Cited by 8 publications

(7 citation statements)

References 29 publications

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“…A systematic review and meta-analysis indicate that the mean OPT per electrode in the robot-assisted group is significantly less than that in the traditional hand-guided group. 24 On the other hand, in another systematic review and meta-analysis on robot-assisted SEEG electrode placementthe mean OPT per electrode of Sinovation (9.9 minutes) was shorter than that of ROSA (11.45 minutes). 25 González-Martínez et al reported the results of 101 robot-assisted SEEG procedures.…”

Section: Discussionmentioning

confidence: 95%

The Value of SINO Robot and Angio Render Technology for Stereoelectroencephalography Electrode Implantation in Drug-Resistant Epilepsy

Dai,

Jiang,

Zhang

et al. 2024

J Neurol Surg A Cent Eur Neurosurg

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Background and objective: Stereo-electroencephalography (SEEG) electrodes are implanted using a variety of stereotactic technologies to treat refractory epilepsy. The value of SINO-robot for SEEG electrode implantation is rarely reported. The aim of the current study was to assess the value of SINO-robot in conjunction with Angio Render technology, in SEEG electrode implantation. We also assess its efficacy by examining factors such as localization error, operation time, and complications. Methods: Between June 2018 and October 2020, we retrospectively reviewed 58 patients who underwent SEEG implantation to resect or ablate their epileptogenic zone (EZ) while minimizing the risk of hemorrhage. SINO-robot combined with Angio Render technology-assisted SEEG electrode implantation was used to visualize each patient’ blood vessel in a 3D plane. The 3D view functionality was used to increase the safety and accuracy of the implantation, and reducing the risk of hemorrhage by avoiding said blood vessel. Results: In this study, 634 SEEG electrodes were implanted in 58 patients. The mean 10.92(range 5- 18) leads per patient. The mean entry point localization error (EPLE) was 0.94 ± 0.23 mm (range: 0.39– 1.63 mm), and the mean target point localization error (TPLE) was 1.49 ± 0.37 mm (range: 0.80–2.78 mm). The mean operating time per lead (MOTPL) was 6. 18 ± 1.80 min (range: 3.02– 14.61 min). And the mean depth of electrodes was 56.96± 3.62 mm (range:27.23–124.85 mm). At a follow-up of at least one year, totally 81.57% (47/58) of patients achieved an Engel class I of seizure freedom. There were 2 patients with asymptomatic brain hematomas following SEEG placement, and no late complications or mortality in this cohort. Conclusions: SINO-robot in conjunction with Angio Render technology assist, in SEEG electrode implantation is safe and accurate in mitigating the risk of intracranial hemorrhage in patients suffering from drug-resistant epilepsy.

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Section: Discussionmentioning

confidence: 95%

The Value of SINO Robot and Angio Render Technology for Stereoelectroencephalography Electrode Implantation in Drug-Resistant Epilepsy

Dai,

Jiang,

Zhang

et al. 2024

J Neurol Surg A Cent Eur Neurosurg

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“…Equipment and techniques used, e.g., frame-based, frameless or robot-assisted systems, can influence implantation accuracy. Previous studies have described sEEG implantation accuracy qualitatively and quantitatively comparing positioning technique (robot-assisted system vs. mechanical arm) and stereotactic frames vs. frameless image-guided systems [for reviews see ( 4 , 5 , 9 )]. Overall, these studies suggest that robot-assisted systems provide a more accurate method of implantation, though there is variability between studies, equipment used, imaging used (CT vs. MRI) and others.…”

Section: Discussionmentioning

confidence: 99%

“…Precise localization of the EZ as well as effective treatment when using sEEG-guided RFA rely on implantation accuracy of sEEG electrodes. Consequently, numerous studies have investigated the implantation accuracy of different sEEG electrodes using in vitro systems (e.g., phantom) (21)(22)(23)(24), cadavers (12) and patients [for reviews see (4,5,9)], and have identified a number of factors that can affect it. These factors include electrode properties, trajectory length and type, surgical equipment used for implantation, registration and referencing methods, and others.…”

Section: Implantation Accuracymentioning

confidence: 99%

“…These include errors involving the implantation systems (e.g., frameless, frame-based or robot-assisted), neuronavigational system (e.g., misregistration between planning and registration scans), trajectory angle and length (e.g., shallow entry angles increase the chances of the drill bit slipping at the start of drilling), electrodetissue interference (e.g., electrode deviations due to structural and biomechanical properties of soft tissue such as heterogeneity, angle when crossing tissue interfaces), surgical technique (e.g., electrode deviations affected by surgical technique such as the use of stylet or anchor bolt), electrode properties (e.g., deviations affected by mechanical properties of the electrodes), and postimplantation physiological response (e.g., cerebrospinal fluid leak, tissue swelling) (4)(5)(6)(7)(8)(9)(10)(11). Two meta-analysis studies have showed that the robot-assisted sEEG electrode implants tend to have better accuracy than frameless or frame-based systems (4,9). A study investigating the angle of the planned trajectory has found that trajectories with a planned angle of >30 had significantly higher EPEs and TPEs than trajectories with planned angles <30 (6,11).…”

Section: Introductionmentioning

confidence: 99%

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Implantation accuracy of novel polyimide stereotactic electroencephalographic depth electrodes—a human cadaveric study

Kullmann,

Akberali,

Van Gompel

et al. 2024

Front. Med. Technol.

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IntroductionStereoelectroencephalography (sEEG) is a minimally invasive procedure that uses depth electrodes stereotactically implanted into brain structures to map the origin and propagation of seizures in epileptic patients. Implantation accuracy of sEEG electrodes plays a critical role in the safety and efficacy of the procedure. This study used human cadaver heads, simulating clinical practice, to evaluate (1) neurosurgeon's ability to implant a new thin-film polyimide sEEG electrode according to the instructions for use (IFU), and (2) implantation accuracy.MethodsFour neurosurgeons (users) implanted 24 sEEG electrodes into two cadaver heads with the aid of the ROSA robotic system. Usability was evaluated using a questionnaire that assessed completion of all procedure steps per IFU and user errors. For implantation accuracy evaluation, planned electrode trajectories were compared with post-implantation trajectories after fusion of pre- and postoperative computer tomography (CT) images. Implantation accuracy was quantified using the Euclidean distance for entry point error (EPE) and target point error (TPE).ResultsAll sEEG electrodes were successfully placed following the IFU without user errors, and post-implant survey of users showed favorable handling characteristics. The EPE was 1.28 ± 0.86 mm and TPE was 1.61 ± 0.89 mm. Long trajectories (>50 mm) had significantly larger EPEs and TPEs than short trajectories (<50 mm), and no differences were found between orthogonal and oblique trajectories. Accuracies were similar or superior to those reported in the literature when using similar experimental conditions, and in the same range as those reported in patients.DiscussionThe results demonstrate that newly developed polyimide sEEG electrodes can be implanted as accurately as similar devices in the marker without user errors when following the IFU in a simulated clinical environment. The human cadaver ex-vivo test system provided a realistic test system, owing to the size, anatomy and similarity of tissue composition to that of the live human brain.

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“…[6,9] However, stereo electroencephalography (SEEG) is currently preferred to diagnose epileptogenic lesions, and its use is increasingly reported. [1,7,10] Implanting intracranial electrodes into planned locations is the key to successful electrocorticography recording and electrical cortical stimulation (ECS). Conventionally, intraoperative fluoroscopy or a navigation system was used to identify the location of the electrodes; however, we could not assess the relationship between the brain gyrus and sulcus until the fusion of preoperative magnetic resonance image (MRI) and postoperative computed tomography (CT).…”

Section: Introductionmentioning

confidence: 99%

Real-time display of intracranial subdural electrodes and the brain surface during an electrode implantation procedure using permeable film

Fujimoto,

Matsuo,

Nakata

et al. 2024

Surgical Neurology International

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Background: Subdural electrode (SDE) implantation is an important method of diagnosing epileptogenic lesions and mapping brain function, even with the current preference for stereoelectroencephalography. We developed a novel method to assess SDEs and the brain surface during the electrode implantation procedure using brain images printed onto permeable films and intraoperative fluoroscopy. This method can help verify the location of the electrode during surgery and improve the accuracy of SDE implantation. Methods: We performed preoperative imaging by magnetic resonance imaging and computed tomography. Subsequently, the images were edited and fused to visualize the gyrus and sulcus better. We printed the images on permeable films and superimposed them on the intraoperative fluoroscopy display. The intraoperative and postoperative coordinates of the electrodes were obtained after the implantation surgery, and the differences in the locations were calculated. Results: Permeable films were created for a total of eight patients with intractable epilepsy. The median difference of the electrodes between the intraoperative and postoperative images was 4.6 mm (Interquartile range 2.9–7.1). The locations of electrodes implanted outside the operation field were not significantly different from those implanted inside. Conclusion: Our new method may guide the implantation of SDEs into their planned location.

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Robot-assisted vs. manually guided stereoelectroencephalography for refractory epilepsy: a systematic review and meta-analysis

Cited by 8 publications

References 29 publications

The Value of SINO Robot and Angio Render Technology for Stereoelectroencephalography Electrode Implantation in Drug-Resistant Epilepsy

The Value of SINO Robot and Angio Render Technology for Stereoelectroencephalography Electrode Implantation in Drug-Resistant Epilepsy

Implantation accuracy of novel polyimide stereotactic electroencephalographic depth electrodes—a human cadaveric study

Real-time display of intracranial subdural electrodes and the brain surface during an electrode implantation procedure using permeable film

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