[Practical Applications of Robot Systems in Epilepsy Surgery].

Abstract

Subdural electrode (SDE) implantation and stereotactic electroencephalography (SEEG) represent two primary invasive monitoring techniques employed in epilepsy surgery. In North America, the advent of commercially available surgical robotic systems has initiated a paradigm shift from SDE to SEEG implantation. Advances in robotic technology have enabled the precise and efficient placement of depth electrodes for SEEG. In Japan, robot-assisted stereotactic electrode placement has been covered by National Health Insurance since 2020, further promoting its adoption. SEEG relies exclusively on intracerebral depth electrodes, which are stereographically inserted through twist drill holes or burr holes, eliminating the need for craniotomy-a requirement for SDE implantation. The planning of electrode trajectories is critical and must be meticulously performed using three-dimensional gadolinium-enhanced magnetic resonance imaging datasets to avoid vascular structures. Unlike SDE, SEEG allows for accurate sampling of cortical areas at the surface of hemispheres and bottom of sulci and deep-seated structures, such as the insular cortex, cingulate gyrus, and medial temporal lobes. This section provides a comprehensive overview of the indications for SEEG, the method of electrode implantation using robotic systems, the advantages of SEEG over other monitoring techniques, and its associated risks.