Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
Department of Neurosurgery, Stanford University, Stanford, CA, USA.
Childs Nerv Syst. 2022 Feb;38(2):263-267. doi: 10.1007/s00381-021-05384-5. Epub 2021 Oct 30.
Robot-assisted stereoelectroencephalography (sEEG) is frequently employed to localize epileptogenic zones in patients with medically refractory epilepsy (MRE). Its methodology is well described in adults, but less so in children. Given the limited information available on pediatric applications, the objective is to describe the unique technical challenges and considerations of sEEG in the pediatric population. In this report, we describe our institutional experience with the technical aspects of robot-assisted sEEG in an exclusively pediatric epilepsy surgery unit, focusing on pre-, intra-, and post-operative nuances that are particular to the pediatric population. The pediatric population presents several unique challenges in sEEG, including reduced skull thickness relative to adults, incomplete neurologic development, and often special behavioral considerations. Pre-operative selection of putative epileptogenic zones requires careful multidisciplinary decision-making. Intraoperative attention to nuances in positioning, clamp selection, registration, and electrode placement are necessary. Activity considerations and electrode migration and removal are key post-operative considerations. Robot-assisted sEEG is a valuable tool in the armamentarium of techniques to characterize MRE. However, special considerations must be given to the pediatric population to optimize safety and efficacy.
机器人辅助立体脑电图（sEEG）常用于定位药物难治性癫痫（MRE）患者的致痫区。其方法在成人中已有详细描述，但在儿童中则较少。鉴于儿科应用的信息有限，本研究旨在描述儿科人群中 sEEG 的独特技术挑战和注意事项。本报告描述了我们机构在专门的儿科癫痫手术单元中使用机器人辅助 sEEG 的技术方面的经验，重点介绍了针对儿科人群的特定的术前、术中及术后细微差别。儿科人群在 sEEG 中存在一些独特的挑战，包括相对于成人而言颅骨较薄、神经发育不完全以及特殊的行为考虑因素。术前致痫区的选择需要仔细的多学科决策。术中需要注意定位、夹选择、注册和电极放置等方面的细微差别。术后需要考虑活动以及电极的迁移和移除。机器人辅助 sEEG 是 MRE 技术特征描述的有效工具。然而，必须针对儿科人群给予特殊考虑，以优化安全性和有效性。
