Fish Charles T, Wittayacharoenpong Thanomporn, Donaldson Christopher, Laing Joshua, Neal Andrew, Simpson Hugh D, Hunn Martin, O'Brien Terence J, Gutman Matthew
Department of Neurosurgery, The Alfred Hospital, Alfred Health, Melbourne, Victoria, Australia.
Department of Neurology, The Alfred Hospital, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
J Clin Neurosci. 2025 Aug;138:111403. doi: 10.1016/j.jocn.2025.111403. Epub 2025 Jun 18.
Stereoelectroencephalography (SEEG) has been used to localise the epileptogenic zone in focal epilepsy for several decades. Our centre's current method of implantation with a CRW Precision Arc system will soon be no longer supported in our region, necessitating alternative devices in SEEG procedures. In this study we compared accuracy, efficiency and safety of the CRW frame with the Autoguide robotic system.
A retrospective review of a prospectively maintained database was performed of all patients in a single Australian institution who underwent SEEG between August 2019 and July 2024. Pre- and post-operative stereotactic image-based analysis was performed, with target accuracy and error measurements, operation time logs, and inpatient notes reviewed.
50 patients with a total of 629 electrodes were identified who had undergone SEEG electrode implantation with the CRW frame and 8 patients with a total of 119 electrodes with the assistance of the Medtronic Autoguide robot. The electrode target point error was significantly lower in the CRW group (1.85 mm [1.23-2.58]) compared to the Autoguide assisted group (2.97 mm [1.81--4.22], p = 0.01). The difference was also significant in the individual parameters of depth error (0.57 vs.1.33 mm, p = 0.01) and the radial error (1.56 vs. 2.25 mm, p = 0.01). Bone entry point error was lower in the CRW group (1.04 vs. 2.32 mm, p < 000.1). However, the Autoguide assisted cases demonstrated a significant reduction in pre-implantation time (104.9 Vs. 129.0 min, p = 0.01) and time per electrode (13.9 vs 17.3 min, p = 0.005) compared to the CRW frame. Neither group recorded any significant adverse events nor required re-implantation due to electrode inaccuracy.
Our experience demonstrates that the Medtronic Autoguide robot can safely be used for SEEG electrode implantation, and has improved the pre-implantation and implantation time per electrode for SEEG cases. However, accuracy in our initial cohort was reduced compared to the CRW frame.
立体定向脑电图（SEEG）已用于局灶性癫痫的致痫区定位数十年。我们中心目前使用CRW精密弧形系统进行植入的方法在我们所在地区很快将不再得到支持，因此在SEEG手术中需要使用替代设备。在本研究中，我们比较了CRW框架与自动导航机器人系统在准确性、效率和安全性方面的差异。
对澳大利亚一家机构2019年8月至2024年7月期间接受SEEG的所有患者的前瞻性维护数据库进行回顾性分析。进行术前和术后基于立体定向图像的分析，包括目标准确性和误差测量、手术时间记录以及住院病历审查。
共确定50例患者使用CRW框架进行了SEEG电极植入，共植入629根电极；8例患者在美敦力自动导航机器人辅助下进行了SEEG电极植入，共植入119根电极。CRW组的电极靶点误差（1.85mm[1.23 - 2.58]）显著低于自动导航辅助组（2.97mm[1.81 - 4.22]，p = 0.01）。深度误差（0.57对1.33mm，p = 0.01）和径向误差（1.56对2.25mm，p = 0.01）的个体参数差异也具有统计学意义。CRW组的骨穿刺点误差较低（1.04对2.32mm，p < 0.001）。然而，与CRW框架相比，自动导航辅助病例的植入前时间（104.9对129.0分钟，p = 0.01）和每根电极的植入时间（13.9对17.3分钟，p = 0.005）显著缩短。两组均未记录到任何严重不良事件，也没有因电极不准确而需要重新植入的情况。
我们的经验表明，美敦力自动导航机器人可安全用于SEEG电极植入，并缩短了SEEG病例的植入前和每根电极的植入时间。然而，与CRW框架相比，我们初始队列中的准确性有所降低。
