Stereo-Electro-Encephalo-graphy (SEEG) Med Robotic Bistand i presurgical Evaluering av Medical Ildfast Epilepsi: A Teknisk merknad
Summary
Stereo-electroencephalography (SEEG) aids in localization of epileptogenic zones, however, remains relatively underutilized in the United States. The goal of this abstract is to provide a brief introduction to the technique of SEEG and further a detailed technique of using robotic assistance in the placement of SEEG electrodes.
Abstract
SEEG er en fremgangsmåte og teknikk som brukes for nøyaktig, invasiv opptak av anfallsaktivitet via tredimensjonale registreringer. Epilepsipasienter som anses aktuelle kandidater for invasiv opptak, er beslutningen om å overvåke gjort mellom subdurale nett versus SEEG. Invasive nervene for epilepsi gjøres på pasienter med komplekse, medisinsk refraktær epilepsi. Målet med invasiv monitorering er å tilby resective kirurgi med håp om at anfall. SEEG fordeler inkluderer tilgang til dype kortikale strukturer, en evne til å lokalisere epileptogen sone (EZ) når subdurale nett har ikke klart å gjøre det, og hos pasienter med ikke-angrepne ekstra timelige epilepsier. I dette manuskriptet, presenterer vi en kortfattet historisk oversikt over SEEG og rapportere om vår erfaring med rammeløse stereotaxy henhold robot. Et viktig steg på SEEG innsetting planlegger elektrode baner. For mest effektivt å registrereictal aktivitet via SEEG baner bør planlegges basert på en hypotese om hvor beslaget aktiviteten stammer den antatte epileptogen sonen (EZ). EZ hypotesen er basert på en standardisert preoperativ workup inkludert video-EEG overvåking, MR (magnetisk resonans), PET (positronemisjonstomografi), ictal SPECT (SPECT), og nevropsykologisk vurdering. Ved hjelp av en mistenkt EZ kan SEEG elektroder plasseres minimal invasiv likevel opprettholde nøyaktighet og presisjon. Kliniske resultater viste at evnen til å lokalisere den EZ i 78% av vanskelige å lokalisere pasienter med epilepsi. 1
Introduction
In medically refractory epilepsy there are many non-invasive pre-surgical tools (scalp EEG., magnetic resonance imaging (MRI), functional MRI, single photon emission computed tomography, positron emission topography, and magnetoencephalography). If these non-invasive evaluations fail to sufficiently localize or define the epileptic zone (EZ) then invasive recording may be indicated. Currently, subdural grids or Stereo-electro-encephalo-graphy (SEEG) are the two most prevalent methods of invasive monitoring. SEEG was originally developed in France in the 1950’s by Jean Talairach and Jean Bancaud; recently it has mostly been used for invasive monitoring of refractory epilepsy patients in France.2-4 SEEG is the consists of stereotactically inserting intracerebral electrodes into the brain parenchyma to record brain electrical activity for an extended period of time. With the intracerebral electrical recordings many patients are able to have their EZ defined to allow for surgical resection.
Despite this long history of success SEEG remains relatively rarely used for invasive recording in America. However, SEEG does offer several significant advantages; SEEG allows for 1) recording of deep structures, 2) bihemispheric recordings, 3) another recording option if subdural grids failed, and 4) mapping of epileptic networks in three dimensions, mainly in patients where non-lesional extra-temporal epilepsy is suspected.5-7 All of these benefits are achieved without requiring a large craniotomy. A recent technologic advance in SEEG surgery is the used of robotic guidance. This sophisticated development allows for improved operative times but safer and more accurate surgical implantation of electrodes.Recently published literature reviews the results of using two different techniques for SEEG insertion; a more traditional method utilizing stereotactic frames and a newer technique using robotic assistante for SEEG insertion.1, 8,15 the results were similarly successful with each method.
With the advent of improved robotic assistance, the SEEG insertion technique has resulted in improved operative times. The robotic system is classified as a supervisory controlled system which means the surgeon plans the operation off line and implicitly specifies the motion the robot must follow to perform the operation.9 The robotic assist results in expedient transitions from one trajectory to the next for the placement of each intracranial electrode.
Protocol
Representative Results
Discussion
Her presenteres teknikken SEEG innsetting utnytte robot stereo hjelp. robot-assistert SEEG mens SEEG ble opprinnelig beskrevet ved hjelp av andre metoder for ramme basert stereotaxis, ikke bare tilbyr tilsvarende sikkerhets men overlegen nøyaktighet og effektivitet. Litteraturen rapporterer suksess ved å lokalisere EZ i over 76% av tilfellene, noe som er uttrykke med andre tidligere studier med alternative teknikker. 6,13,.
Som med alle invasiv hjerne prosedyre, er SEEG ikke ute…
Disclosures
The authors have nothing to disclose.
Acknowledgements
Forfatterne har ingen bekreftelser.
References
- Serletis, D., Bulacio, J., Bingaman, W., Gonzalez-Martinez, J. The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients. J Neurosurg. 121, 1239-1246 (2014).
- Bancaud, J. Epilepsy after 60 years of age. Experience in a functional neurosurgical department. Sem Hop. 46, 3138-3140 (1970).
- Bancaud, J., et al. Functional stereotaxic exploration (SEEG) of epilepsy. Electroencephalogr Clin Neurophysiol. 28, 85-86 (1970).
- Talairach, J., Bancaud, J., Bonis, A., Szikla, G., Trottier, S., Vignal, J. P. Surgical therapy for frontal epilepsies. Adv Neurol. 57, 707-732 (1992).
- Vadera, S., Mullin, J., Bulacio, J., Najm, I., Bingaman, W., Gonzalez-Martinez, J. Stereo electroencephalography following subdural grid placement for difficult to localize epilepsy. Neurosurgery. 72, 723-729 (2013).
- Munari, C., et al. Stereo-electroencephalography methodology: advantages and limits. Acta Neurol Scand Suppl. 152, 56-69 (1994).
- Gonzalez-Martinez, J., Bulacio, J., Alexopoulos, A., Jehi, L., Bingaman, W., Najm, I. Stereoelectroencephalography in the “difficult to localize” refractory focal epilepsy early experience from a North American epilepsy center. Epilepsia. 54, 323-330 (2013).
- Gonzalez-Martinez, J., et al. Stereotactic placement of depth electrodes in medically intractable epilepsy. Technicalnote. J Neurosurg. 120, 639-664 (2014).
- Nathoo, N., Lu, M. C., Vogelbaum, M., Barnett, G. H. In Touch with Robotics: Neurosurgery for the Future. Neurosurgery. 56, 421-433 (2005).
- De Almeida, A. N., Olivier, A., Quesney, F., Dubeau, F., Savard, G., Andermann, F. Efficacy of and morbidity associated with stereoelectroencephalography using computerized tomography-or magnetic resonance imaging-guided electrode implantation. J Neurosurg. 104, 483-487 (2006).
- Cossu, M., et al. Stereoelectroencephalography in the presurgical evaluation of focal epilepsy a retrospective analysis of 215 procedures. Neurosurgery. 57, 706-718 (2005).
- Gonzalez-Martinez, J., et al. Robot-assisted stereotactic laser ablation in medically intractable epilepsy: operative technique. Neurosurgery. 10, 167-172 (2014).
- Guenot, M., et al. Neurophysiological monitoring for epilepsy surgery: the Talairach SEEG method. Indications, results, complications and therapeutic applications in a series of 100 consecutive cases. Stereotact Funct Neurosurg. 77, 29-32 (2001).
- Kuzniecky, R. I., et al. Multimodality MRI in mesial temporal sclerosis: relative sensitivity and specificity. Neurology. 49 (3), 774-778 (1997).
- Cardinale, F., et al. Stereoelectroencephalography: surgical methodology, safety, and stereotacticapplication accuracy in 500 procedures. Neurosurgery. 72 (3), 353-366 (2013).
