Artikel
Stereotactic robot assisted placement of intracerebral depth electrodes in paediatric and adult patients – accuracy, complications and epileptological results
Roboter-assistierte stereotaktische Implantation intrazerebraler Tiefenelektroden bei pädiatrischen und erwachsenen Patienten – Präzision, Komplikationen und epileptologische Ergebnisse
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Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: The number of patients requiring depth electrode implantation for invasive video EEG diagnostics increases in most epilepsy centres. Here we report on our institutional experience with frameless robot-assisted stereotactic placement of intracerebral depth electrodes using the Neuromate® stereotactic robot-system.
Methods: We identified all patients undergoing robot-assisted stereotactic placement of intracerebral depth electrodes for invasive extra-operative epilepsy monitoring between September 2013 and March 2020. We studied technical (placement) and diagnostic accuracy of the robot-assisted procedure, associated surgical complications and procedural time requirements.
Results: 464 depth electrodes were implanted in 74 patients (mean 6 per patient, range 1-12). There were 27 children and 47 adults (age range: 3.6–64.6 yrs.). The mean entry and target point errors were 1.82±1.15 and 1.98±1.05 mm. Target and entry point errors were significantly higher in paediatric vs. adult patients and for electrodes targeting the temporo-mesial region. There were no clinically relevant haemorrhages and no infectious complications. Mean time for the placement of one electrode was 37±14 min and surgery time per electrode decreased with the number of electrodes placed. 55 patients (74.3 %) underwent definitive surgical treatment. After a median follow-up of 24 (range 6-72) months 39/54 (72.2 %) patients were seizure-free (ILAE 1).
Conclusion: Frameless robot-guided stereotactic placement of depth electrodes with the Neuromate® stereotactic robot-system is safe and feasible even in very young children, with good in vivo accuracy and high diagnostic precision. The surgical workflow is time-efficient and further improves with increasing numbers of implanted electrodes.