Neurological Surgery Unit, Division of Surgery, Faculty of Medicine, Prince of Songkla University.
Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center.
Neurol Med Chir (Tokyo). 2024 Feb 15;64(2):71-86. doi: 10.2176/jns-nmc.2023-0119. Epub 2024 Jan 15.
The aim of this study was to systematically review and meta-analyze the efficiency and safety of using the Robotic Stereotactic Assistance (ROSA) device (Zimmer Biomet; Warsaw, IN, USA) for stereoelectroencephalography (SEEG) electrode implantation in patients with drug-resistant epilepsy. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was carried out. Overall, 855 nonduplicate relevant articles were determined, and 15 of them were selected for analysis. The benefits of the ROSA device use in terms of electrode placement accuracy, as well as operative time length, perioperative complications, and seizure outcomes, were evaluated. Studies that were included reported on a total of 11,257 SEEG electrode implantations. The limited number of comparative studies hindered the comprehensive evaluation of the electrode implantation accuracy. Compared with frame-based or navigation-assisted techniques, ROSA-assisted SEEG electrode implantation provided significant benefits for reduction of both overall operative time (mean difference [MD], -63.45 min; 95% confidence interval [CI] from -88.73 to -38.17 min; P < 0.00001) and operative time per implanted electrode (MD, -8.79 min; 95% CI from -14.37 to -3.21 min; P = 0.002). No significant differences existed in perioperative complications and seizure outcomes after the application of the ROSA device and other techniques for electrode implantation. To conclude, the available evidence shows that the ROSA device is an effective and safe surgical tool for trajectory-guided SEEG electrode implantation in patients with drug-resistant epilepsy, offering benefits for saving operative time and neither increasing the risk of perioperative complications nor negatively impacting seizure outcomes.
本研究旨在系统地回顾和荟萃分析使用机器人立体定向辅助（ROSA）设备（美国 Zimmer Biomet；华沙，IN）进行耐药性癫痫患者立体脑电图（SEEG）电极植入的效率和安全性。根据系统评价和荟萃分析的首选报告项目指南进行文献检索。总共确定了 855 篇非重复相关文章，并选择了其中的 15 篇进行分析。评估了 ROSA 设备在电极放置准确性、手术时间长度、围手术期并发症和癫痫发作结果方面的优势。纳入的研究报告了总共 11,257 个 SEEG 电极植入。有限数量的对照研究阻碍了对电极植入准确性的全面评估。与框架或导航辅助技术相比，ROSA 辅助 SEEG 电极植入在缩短总手术时间（平均差值 [MD]，-63.45 分钟；95%置信区间 [CI] 从-88.73 至-38.17 分钟；P < 0.00001）和每个植入电极的手术时间（MD，-8.79 分钟；95%CI 从-14.37 至-3.21 分钟；P = 0.002）方面都有显著获益。在应用 ROSA 设备和其他电极植入技术后，围手术期并发症和癫痫发作结果没有显著差异。总之，现有证据表明，ROSA 设备是一种有效的、安全的手术工具，可用于引导轨迹的耐药性癫痫患者的 SEEG 电极植入，具有节省手术时间的优势，既不会增加围手术期并发症的风险，也不会对癫痫发作结果产生负面影响。
