A 2-Year Experience of Robot-Assisted Epilepsy Surgery Using a New Cranial Robotic System With Optical Tracking: Variables Influencing Accuracy and Complications.

Abstract

Background and objectives: Our institution began using the Globus ExcelsiusGPS cranial robot in 2023 for placement guidance in epilepsy surgeries including depth electrodes for stereoelectroencephalography (SEEG), laser interstitial thermal therapy (LITT), NeuroPace responsive neurostimulator, and Medtronic deep brain stimulator. In our first 2 years, we performed 58 epilepsy surgeries for 37 patients using the robot for 466 trajectories. Surgery time, accuracy of trajectory, and hemorrhage rate were analyzed.

Methods: We performed a retrospective chart review of epilepsy surgeries using the Globus ExcelciusGPS cranial robot over our first 2 years of experience. Potential influencing factors analyzed included trajectory length, skull thickness, angle of trajectory with the skull, imaging used for registration, head holder, stabilization of the head, drill used, brain location, type of surgery, the number of each case performed, and the number of trajectories placed. We also analyzed hemorrhage rate and surgery time. Factorial analysis of variance, multiple regression, and Pearson correlation statistics were used.

Results: Accuracy of electrode or laser placement was significantly affected by imaging modality used for robot registration (P = .018), head holder used (P = .014), and the trajectory plan's angle from skull perpendicular (P < .001). The time required for placement per trajectory varied, with SEEG being the fastest and LITT being the slowest (P < .001). There were no symptomatic hemorrhages in this series, with 3 asymptomatic SEEG surgery subarachnoid hemorrhages (9.7% per surgery, 0.7% per electrode) and 2 asymptomatic LITT surgery parenchymal hemorrhages (15% per surgery, 10% per laser). There were no responsive neurostimulator or deep brain stimulator hemorrhages.

Conclusion: The accuracy of surgery using the Globus ExcelsiusGPS robot was influenced by factors including the trajectory plan and equipment used. The type of surgery performed influenced the amount of surgical time. These findings may improve the efficiency and accuracy of epilepsy surgery using this cranial robot.