Application of robot-assisted stereoencephalography electrode implantation in epilepsy surgery

Objective To explore the precision, efficiency and safety of robot-assisted stereoencephalography (SEEG) electrode implantation applied in epilepsy surgery. Methods A retrospective analysis was conducted on 23 patients of refractory epilepsy who were admitted to Beijing Institute of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University from February 2018 to June 2018 and underwent robot-assisted SEEG electrode implantation ('robot’ group). A total of 25 refractory epilepsy patients admitted from October 2017 to January 2018 underwent CRW stereotactic apparatus-guided SEEG implantation and served as control ('CRW’ group). Continuous thin-slice CT was conducted post operation in each case, based on which the distance between the actual and planned target of each electrode trajectory was measured and set as operational deviation.Operational duration for each electrode implantation and incidences of postoperative complications were documented. The parameters as above were compared between the 2 groups. Results In the 'robot’ group, a total of 179SEEG electrodes with 2 642 contacts were implanted in this series (23 cases), with the median of 8 (5-10) electrodes with 120 (76-136)contacts in each patient.In the 'CRW’ group, 25 patients underwent implantation of 172 electrodes with 2 520 contacts, with the median of 7 (6-9)electrodes with 100 (60-128) contacts in each patient.The operational deviation of each electrode was 1.4 (0.4-9.3) mm ('robot’ group) and 1.4 (0-4.6) mm ('CRW’ group), respectively, which had no statistical difference (P>0.05). Compared with 'CRW’ group, the 'robot’ group had significantly shorter operational duration[8(5.9-12.8) min vs. 14.7 (10.3-18.5) min, P<0.01] for each electrode implantation. In the 'robot’ group, there were 2 cases (8.7%) of asymptomatic intracranial hemorrhage. No cases of infection or other complications were observed. In the 'CRW’ group, there were 1 case (4.0%) of intracerebral hemorrhage causing contralateral paralysis, 1 case (4.0%) of asymptomatic hemorrhage and no cases of other complications. Conclusions Robot-assisted technique seems to be able to remarkedly increase the efficiency of SEEG electrode implantation with relatively good precision and safety, which could thus be recommended for clinical use and promotion. Key words: Epilepsy; Neurosurgical procedures; Robot; Stereotaxic techniques; Intracranial electrode