Santiago Candela-Cantó1,2, Javier Aparicio3, Jordi Muchart López3,4, Pilar Baños-Carrasco5,3, Alia Ramírez-Camacho3, Alejandra Climent3, Mariana Alamar5,3, Cristina Jou3,6, Jordi Rumià5,3,7, Victoria San Antonio-Arce3, Alexis Arzimanoglou3,8, Enrique Ferrer5,3,7. 1. Pediatric Neurosurgery Department, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain. scandela@sjdhospitalbarcelona.org. 2. Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain. scandela@sjdhospitalbarcelona.org. 3. Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain. 4. Diagnostic Imaging Department, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona, Barcelona, Spain. 5. Pediatric Neurosurgery Department, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain. 6. Pathology Department, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona, Barcelona, Spain. 7. Neurosurgery Department, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain. 8. Pediatric Epilepsy, Sleep and Neurophisiology Department, Centre Hospitalier Universitaire de Lyon and Hospital Femme-Mère-Enfant, Lyon, France.
Abstract
BACKGROUND: Stereoelectroencephalography (SEEG) is an effective technique to help to locate and to delimit the epileptogenic area and/or to define relationships with functional cortical areas. We intend to describe the surgical technique and verify the accuracy, safety, and effectiveness of robot-assisted SEEG in a newly created SEEG program in a pediatric center. We focus on the technical difficulties encountered at the early stages of this program. METHODS: We prospectively collected SEEG indication, intraoperative events, accuracy calculated by fusion of postoperative CT with preoperative planning, complications, and usefulness of SEEG in terms of answering preimplantation hypothesis. RESULTS: Fourteen patients between the ages of 5 and 18 years old (mean 10 years) with drug-resistant epilepsy were operated on between April 2016 and April 2018. One hundred sixty-four electrodes were implanted in total. The median entry point localization error (EPLE) was 1.57 mm (1-2.25 mm) and the median target point localization error (TPLE) was 1.77 mm (1.2-2.6 mm). We recorded seven intraoperative technical issues. Two patients suffered complications: meningitis without demonstrated germ in one patient and a right frontal hematoma in the other. In all cases, the SEEG was useful for the therapeutic decision-making. CONCLUSION: SEEG has been useful for decision-making in all our pediatric patients. The robotic arm is an accurate tool for the insertion of the deep electrodes. Nevertheless, it is an invasive technique not risk-free and many problems can appear at the beginning of a robotic arm-assisted SEEG program that must be taken into account beforehand.
BACKGROUND: Stereoelectroencephalography (SEEG) is an effective technique to help to locate and to delimit the epileptogenic area and/or to define relationships with functional cortical areas. We intend to describe the surgical technique and verify the accuracy, safety, and effectiveness of robot-assisted SEEG in a newly created SEEG program in a pediatric center. We focus on the technical difficulties encountered at the early stages of this program. METHODS: We prospectively collected SEEG indication, intraoperative events, accuracy calculated by fusion of postoperative CT with preoperative planning, complications, and usefulness of SEEG in terms of answering preimplantation hypothesis. RESULTS: Fourteen patients between the ages of 5 and 18 years old (mean 10 years) with drug-resistant epilepsy were operated on between April 2016 and April 2018. One hundred sixty-four electrodes were implanted in total. The median entry point localization error (EPLE) was 1.57 mm (1-2.25 mm) and the median target point localization error (TPLE) was 1.77 mm (1.2-2.6 mm). We recorded seven intraoperative technical issues. Two patients suffered complications: meningitis without demonstrated germ in one patient and a right frontal hematoma in the other. In all cases, the SEEG was useful for the therapeutic decision-making. CONCLUSION: SEEG has been useful for decision-making in all our pediatric patients. The robotic arm is an accurate tool for the insertion of the deep electrodes. Nevertheless, it is an invasive technique not risk-free and many problems can appear at the beginning of a robotic arm-assisted SEEG program that must be taken into account beforehand.
Authors: Barbara Ladisich; Lukas Machegger; Alexander Romagna; Herbert Krainz; Jürgen Steinbacher; Markus Leitinger; Gudrun Kalss; Niklas Thon; Eugen Trinka; Peter A Winkler; Christoph Schwartz Journal: Acta Neurochir (Wien) Date: 2021-02-13 Impact factor: 2.216