Evaluation of the accuracy, efficiency and safety of Stereoelectroencephalography with robotic assisted electrode placement compared to traditional frame based stereotaxy.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.