Tıbbi Refrakter Epilepsi Cerrahi öncesi Değerlendirilmesi Robotik Yardım ile stereo-Elektro-Ensefalo-Graphy (Seeg): Bir Teknik Not
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 üç boyutlu kayıtları ile nöbet aktivitesi, doğru invaziv kayıt için kullanılan bir yöntem ve bir tekniktir. invaziv kayıtlar için uygun adaylar görülen epilepsi hastalarında, izlemek için karar Seeg karşı subdural grid arasında yapılır. Epilepsi için İnvaziv nörolojik karmaşık, ilaca dirençli epilepsi hastalarında takip edilmektedir. invaziv izleme amacı nöbet özgürlüğü sağlayan umudu ile rezektif cerrahi sunmaktır. Seeg avantajları derin kortikal yapılarda erişimi, Epileptojenik bölge subdural ızgaraları bunu başarısız olmuş (EZ) ve non-lezyonel ekstra temporal epilepsilerde olan hastalarda lokalize bir yeteneği vardır. Bu yazıda, Seeg bir özlü tarihsel bir bakış sunmak ve robot altında çerçevesiz stereotaksi ile bizim deneyim hakkında rapor. Seeg yerleştirilmesi bir zorunluluk adım elektrot yörüngelerini planlıyor. en etkili kayıt içinSeeg yörüngeleri aracılığıyla iktal aktivite nöbet aktivitesi kabul epileptojenik bölge (EZ) nereden geldiğine bir hipoteze dayalı planlanmalıdır. EZ hipotezi, video-EEG monitorizasyonu, MRG (manyetik rezonans görüntüleme), PET (pozitron emisyon tomografisi), iktal SPECT (Tek foton emisyon bilgisayarlı tomografi) ve nöropsikolojik değerlendirme de dahil olmak üzere standart preoperatif değerlendirmenin dayanmaktadır. şüpheli EZ kullanarak, Seeg elektrotlar minimal invaziv henüz doğruluğu ve kesinliği korumak yerleştirilebilir. Klinik sonuçlar epileptik hasta lokalize zor% 78'inde EZ lokalize etmek yeteneğini gösterdi. 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
İşte robotik stereotaktik yardım kullanan Seeg yerleştirme tekniği sunulmaktadır. Seeg başlangıçta çerçeve tabanlı stereotaksiyi diğer yöntemler kullanılarak tarif ederken, robot yardımlı Seeg benzer güvenlik fakat üstün doğruluk ve verimlilik sadece sunmaktadır. Diğer önceki çalışmalar, alternatif teknikler kullanılarak. 6,13 ile kederini olduğu durumlarda 76 üzerinden% içinde EZ lokalize edebiyat raporları başarı.
herhangi bir invazif…
Disclosures
The authors have nothing to disclose.
Acknowledgements
Yazarlar hiçbir onayları var.
References
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