出处《中华神经外科疾病研究杂志》CAS
2016年第4期308-308,共1页
Chinese Journal of Neurosurgical Disease Research
关键词癫痫精确度深度电极机器人OBJECTIVE The authors＇group recently published a novel technique for a navigation-guided frameless stereotactic approach for the placement of depth electrodes in epilepsy patients. To improve the accuracy of the trajectory and enhance the procedural workflow, the authors implemented the iSysl miniature robotic device in the present study into this routine. METHODS As a first step, a preclinical phantom study was performed using a human skull model, and the accuracy and timing between 5 electrodes implanted with the manual technique and 5 with the aid of the robot were compared. After this phantom study showed an increased accuracy with robot-as- sisted electrode placement and confirmed the robot ability to maintain stability despite the rotational forces and the leverage effect from drilling and screwing, patients were enrolled and analyzed for robot-assisted depth electrode placement at the anthors＇institntion from Janu- ary 2014 to December 2015. All procedures were performed with the $7 Surgical Navigation System with Synergy Cranial software and the iSysl miniature robotic device. RESULTS Ninety-three electrodes were implanted in 16 patients （median age 33 years, range 3 -55 years 9 females, 7 males）. The authors saw a significant increase in accuracy compared with their manual technique, with a median deviation from the planned entry and target points of 1.3 mm （ range 0.1 - 3.4 mm） and 1.5 mm （ range 0.3 - 6.7 mm）, respectively. For the last 5 patients （ 31 electrodes） of this series the authors modified their technique in placing a guide for implantation of depth electrodes （GIDE） on the bone and saw a significant further increase in the accuracy at the entry point to 1.18 ± 0.5 mm （mean ：1： SD） compared with 1.54 ± 0.8 mm for the first 11 patients （ P = 0.021 ）. The median length of the trajectories was 45.4 mm （ range 19 ± 102.6 mm）. The mean duration of depth electrode placement from the start of trajectory alignment to fixation of the electrode was 15.7 minutes （range 8.5 -26.6 minutes）, which was significantly faster than with the manual technique. In 12 patients, depth electrode placement was combined with subdural electrode placement. The procedure was well tolerated in all patients. The authors did not encounter any case of hemorrhage or neurological deficit related to the electrode placement. In 1 patient with a psoriasis vulgaris, a superficial wound infection was encountered. Adequate physiological recordings were obtained from all electrodes. No additional electrodes had to be implanted because of misplacement. CONCLUSIONS The iSysl robotic device is a versatile and easy to use tool for frameless implantation of depth electrodes for the treatment ofepilepsy. It increased the accuracy of the authors＇manual technique by 60% at the entry point and over 30% at the target. It further enhanced and expedited the authors＇procedural workflow.
