Lu Chao, Chen Sichang, An Yang, Meng Fei, Wang Yihe, Wei Penghu, Fan Xiaotong, Shan Yongzhi, Zhao Guoguang
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China.
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.
Ann Palliat Med. 2021 Apr;10(4):3699-3705. doi: 10.21037/apm-20-2123. Epub 2021 Mar 10.
A frameless stereotactic robot-assisted system allows stereoelectroencephalography (SEEG) electrodes to span multiple lobes. As the angularity and length are increased, maintaining accuracy of the electrodes becomes more challenging. The goal of this study was to analyze the factors that influence the accuracy of multilobe-spanning SEEG electrodes inserted using a frameless stereotactic robot-assisted system.
A total of 322 SEEG electrodes were implanted in 39 patients with refractory epilepsy, and sixty-one multilobe-spanning SEEG electrodes were selected to analyze the factors that influenced the accuracy of implantation. The target error, entrance error, depth error, and angular error were calculated by a specialized computer program. Factors including electrode depth, angular deviation, referencing method, head holder choice, and use of a predrill procedure were analyzed to determine their effects on accuracy.
Thirty-nine patients (aged 2-35 years, median: 19 years; 21 females) underwent frameless robot-assisted SEEG electrode implantation. The mean distance between the intended target and actual tip location was 2.57±1.70 mm (range, 0.42-9.02 mm). The mean distance between the intended entrance point and the actual location was 2.2±1.29 mm (range, 0.70-6.13 mm). The mean length of the electrodes was 84.63±7.61 mm (range, 70.60-103.99 mm). The depth error was 1.36±1.22 mm (range, 0.03-6.69 mm), and the angular deviation was 1.64±1.12 degrees (range, 0.15-4.93 degrees). Multifactor regression analysis showed that entrance error, electrode depth, depth error, angular deviation, referencing method, and head holder choice could explain 59.5% of the electrode target error. Angular deviation, choice of registration approach and head holder and the use of a predrill procedure could explain 48.1% of the electrode entrance error. Use of a predrill procedure significantly reduced the electrode angular deviation (P<0.05).
Head holder choice, use of a predrill procedure and angular deviation are the primary influencing factors of the accuracy of multilobe-spanning SEEG electrode placement. The Leksell frame and a predrill procedure can be used to increase the accuracy of SEEG electrode placement.
无框架立体定向机器人辅助系统可使立体脑电图（SEEG）电极跨越多个脑叶。随着电极角度和长度增加，维持电极准确性变得更具挑战性。本研究目的是分析影响使用无框架立体定向机器人辅助系统插入的跨多脑叶SEEG电极准确性的因素。
共39例难治性癫痫患者植入322根SEEG电极，选取61根跨多脑叶的SEEG电极分析影响植入准确性的因素。通过专门计算机程序计算靶点误差、入点误差、深度误差和角度误差。分析电极深度、角度偏差、参考方法、头架选择和预钻孔操作等因素对准确性的影响。
39例患者（年龄2 - 35岁，中位数：19岁；女性21例）接受无框架机器人辅助SEEG电极植入。预期靶点与实际电极尖端位置的平均距离为2.57±1.70 mm（范围0.42 - 9.02 mm）。预期入点与实际位置的平均距离为2.2±1.29 mm（范围0.70 - 6.13 mm）。电极平均长度为84.63±7.61 mm（范围70.60 - 103.99 mm）。深度误差为1.36±1.22 mm（范围0.03 - 6.69 mm），角度偏差为1.64±1.12度（范围0.15 - 4.93度）。多因素回归分析显示，入点误差、电极深度、深度误差、角度偏差、参考方法和头架选择可解释59.5%的电极靶点误差。角度偏差、配准方法和头架的选择以及预钻孔操作可解释48.1%的电极入点误差。使用预钻孔操作显著降低电极角度偏差（P<0.05）。
头架选择、预钻孔操作的使用和角度偏差是跨多脑叶SEEG电极放置准确性的主要影响因素。Leksell框架和预钻孔操作可用于提高SEEG电极放置的准确性。
