Introduction: Robotic-assisted neurosurgery has greatly advanced over the last 30 years. One of the applications of stereotactic robots is the implantation of depth electrodes for stereoelectroencephalography (SEEG) during the presurgical work-up for drug-refractory epilepsy. However, only a few clinical studies have highlighted its advantages and directly compared its efficacy and safety to conventional frame-based implantation methods.
Methods: The transition from stereotactic Leksell frame-based to robot-assisted SEEG at the London Health Science Centre Epilepsy Program was analyzed with the main focus on databank-acquired operative time, radiation exposure, complications, and accuracy.
Results: A cohort of N=118 patients with drug-refractory epilepsy undergoing depth electrodes implantation were reviewed (n=97 before and n=21 after the introduction of the robot). Baseline characteristics were well-balanced between groups. Operative time could be significantly shortened from 140.8±45 to 91.1±38 min (16.2±7.9 to 9±4.6 min per electrode format; both p<0.01). Also, radiation exposure in terms of dose area product (19.5±35.5 vs. 8.5±4.6 rad*cm2 per electrode; p<0.01) and fluoroscopy time (4.7±7.1 vs. 2.7±1.2 sec per electrode; p<0.05) were significantly decreased. There was no increase in the rate of complications, and robot-assisted entry point (1.2±0.8 mm) and target point (2.1±0.8 mm) accuracy were comparable to the literature.
Conclusions: In our institutional series, robot-assisted SEEG reduces human error, enhances patient safety, is less time-consuming and decreases radiation exposure with excellent accuracy in comparison to conventional stereotactic Leksell frame-based SEEG.
Patient Care: In light of the results of the current study in conjunction with the literature on stereotactic robots, the evidence converges that robot-assisted implantation of depth electrodes for SEEG can greatly improve patient care during the presurgical work-up for drug-refractory epilepsy for the following reasons: Less human error, greater patient safety, shorter operative time, decreased radiation exposure, and improved accuracy.
Learning Objectives: The introduction of a stereotactic robot can greatly hasten institutional workflow and benefit patient safety after the learning curve has been overcome, especially in multi-target stereotactic procedures such as SEEG.