Introduction: Stereoelectroencephalography (SEEG) is a useful method to localize seizure onset when non-invasive methods have failed to do so. Advantages of SEEG include its relatively minimally invasive approach, deep access, and ability to localize multifocal seizure onsets. SEEG placement using robotic surgical assistance (ROSA) has become widely used, however, there has been little work comparing outcomes between ROSA guided and traditional frame-based SEEG placement. The objective of this work was to compare to efficacy and complications of ROSA versus frame based SEEG placement.
Methods: Retrospective chart review of 106 medically refractory epilepsy patients who underwent ROSA or frame-based SEEG placement at Massachusetts General Hospital from 2006 to 2017. Patients were excluded if they had accompanying subdural grid, strip or foramen ovale electrodes, placed at the time of surgery. After exclusions, 25 patients underwent frame-based or ROSA guided SEEG placement during the study period. Data acquired included seizure origin, number and location of implanted electrodes, number of days electrodes remained, complications arising from placement, if depth placement resulted in diagnosis, and surgical outcome.
Results: SEEG investigation was diagnostic in 92% of ROSA procedures and 64% of frame-based procedures (p = 0.09), which resulted in patients with ROSA SEEG receiving higher rates of surgical intervention (p = 0.03). ROSA and frame-based SEEG placement did not have differing total complications rates (p = 0.48). However, patients undergoing frame-based placement had significantly higher occurrences of non-hemorrhagic complications (P < 0.01, Fisher's exact test). Additionally, patients undergoing ROSA placement had longer operative times compared to frame-based SEEG placement (P = 0.001).
Conclusions: Both ROSA and frame-based SEEG placement are safe and practical approaches to localize seizure foci in refractory epilepsy. However, when deciding which method to use, surgeons should consider the increased occurrence of non-hemorrhagic complications with the frame-based approach and the advanced diagnostic effectiveness of ROSA assisted placement.
Patient Care: This research will improve patient care by informing neurosurgeons on the best method of epileptic foci diagnosis, with the lowest rate of adverse effects and best outcomes.
Learning Objectives: 1. To compare the efficacy of ROSA versus frame based SEEG placement.
2. To compare the complications of ROSA versus frame based SEEG placement.