Alekseev I M, Pekov Zh Zh, Pedyash N V, Zuev A A
Pirogov National Medical Surgical Center, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2024;88(1):28-38. doi: 10.17116/neiro20248801128.
Robot-assisted implantation of deep electrodes for stereo-EEG monitoring has become popular in recent years in patients with drug-resistant epilepsy. However, there are still few data on safety of this technique.
To assess the incidence of complications in patients with drug-resistant epilepsy undergoing robot-assisted implantation of stereo-EEG electrodes.
We retrospectively studied the results of implantation of stereo-EEG electrodes in 187 patients with drug-resistant epilepsy. All patients underwent non-invasive preoperative examination (video-EEG, MRI, PET, SPECT, MEG). In case of insufficient data, stereo-EEG monitoring was prescribed. We determined electrode insertion trajectory using a robotic station and MR images. Implantation of electrodes was carried out using a Rosa robot (Medtech, France). All patients underwent invasive EEG monitoring after implantation.
There were 11.25±3 electrodes per a patient. Implantation of one electrode took 7.5±4.9 min. Postoperative MRI revealed electrode malposition in 2.3% of cases. None was associated with complications. The complication rate per electrode was 0.6%. Complications affected stereo-EEG monitoring only in 3 cases (1.6%). The mortality rate was 0.5%. Bilateral implantation (=0.005), insular (=0.040) and occipital (=0.045) deep electrode implantation were associated with lower incidence of complications. Longer duration of the procedure influenced the incidence of electrode placement in the lateral ventricle (=0.028), and implantation in the frontal lobe was more often associated with epidural placement of electrodes (=0.039).
Robot-assisted implantation of stereo-EEG electrodes is a safe procedure with minimal risk of complications. Rare electrode malposition does not usually affect invasive monitoring.
近年来，机器人辅助植入深部电极用于立体脑电图（stereo-EEG）监测在耐药性癫痫患者中已变得流行。然而，关于该技术安全性的数据仍然很少。
评估接受机器人辅助植入立体脑电图电极的耐药性癫痫患者的并发症发生率。
我们回顾性研究了187例耐药性癫痫患者立体脑电图电极植入的结果。所有患者均接受了术前无创检查（视频脑电图、磁共振成像、正电子发射断层扫描、单光子发射计算机断层扫描、脑磁图）。若数据不足，则安排立体脑电图监测。我们使用机器人工作站和磁共振图像确定电极插入轨迹。电极植入使用Rosa机器人（法国Medtech公司）进行。所有患者在植入后均接受了侵入性脑电图监测。
每位患者平均植入11.25±3根电极。植入一根电极耗时7.5±4.9分钟。术后磁共振成像显示2.3%的病例电极位置不当。均未伴有并发症。每根电极的并发症发生率为0.6%。仅3例（1.6%）并发症影响了立体脑电图监测。死亡率为0.5%。双侧植入（P = 0.005）、岛叶（P = 0.040）和枕叶（P = 0.045）深部电极植入与较低的并发症发生率相关。手术时间越长影响侧脑室电极放置的发生率（P = 0.028）, 额叶植入更常与电极硬膜外放置相关（P = 0.039）。
机器人辅助植入立体脑电图电极是一种安全的手术，并发症风险极小。罕见的电极位置不当通常不影响侵入性监测。
