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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Improving the accessibility of the temporal lobe to invasive pre-surgical evaluation of refractory epilepsy by stereoelectroencephalography

Verbesserung der Zugänglichkeit des Lobus temporalis für die invasive präoperative Beurteilung refraktärer Epilepsie durch Stereoelektroenzephalographie

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  • presenting/speaker Mykola Gorbachuk - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Kathrin Machetanz - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Silke Ethofer - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Florian Grimm - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Thomas V. Wuttke - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Marcos Tatagiba - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Sabine Rona - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Jürgen B. Honegger - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Alireza Gharabaghi - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Georgios Naros - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV027

doi: 10.3205/22dgnc027, urn:nbn:de:0183-22dgnc0270

Published: May 25, 2022

© 2022 Gorbachuk et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Invasive video-encephalography (iVEEG) is the gold standard for pre-surgical evaluation of refractory epilepsy. Traditionally, the presumed epileptic focus was covered with subdural electrodes (SDE) with an invasive implantnation procedure prone to complications. The introduction of stereoencephalography (SEEG) promised a reduction of invasiveness and surgical risk. However, SEEG surgery with conventional frame-based stereotaxy turned out to be time-consuming and impeded by the geometry of the frame. The introduction of robot-assisted SEEG simplified trajectories to the temporal lobe. The aim of the present study was to describe the evolution of invasive video-encephalography of the temporal lobe focusing on the impact of the robotic technology.

Methods: This retrospective study enrolled 57 consecutive patients with medically intractable epilepsy who underwent iVEEG of a potential temporal seizure onset zone (SOZ) by SDE (n=40) or SEEG (n=17). Surgical time efficiency was analyzed by the skin-to-skin time (STS) and the total procedure time (TPT). Surgical risk was depicted by the 90-day complication rate. Temporal SOZ were treated by second stage resective surgery (SSRS). Favorable outcome (Engel°1) was assessed after one year of follow-up.

Results: Robot-assisted (ra) SEEG implantations significantly reduced the duration of surgery in comparison to SDE implantations concerning STS (74±26 vs 173±69 min, p<0.001) and TPT (128±36 vs 208±81 min; p<0.001). Ra SEEG were associated with less severe complications and showed a smaller total complication rate (13% vs 8%, p=0.695) than SDE implantations. Temporal SOZ was detected in 33/40 (83%) SDE and in 9/17 (53%) SEEG cases (p=0.045). 29/42 (69%) of patients with temporal SOZ underwent SSRS. Both SDE and SEEG showed excellent positive prediction for a favorable SSRS outcome (92% vs 100%, p=1.00).

Conclusion: Robot-assisted SEEG improves the accessibility of the temporal lobe to iVEEG by increasing surgical time efficiency and decreasing the complication rate while maintaining a high predictive value for a SSRS.