睿米手术机器人辅助下SEEG电极植入术在药物难治性癫痫中的临床应用

Remebot robot-assisted stereotactic electroencephalography electrode implantation in patients with medically-refractory epilepsy

目的探讨国产睿米手术机器人辅助下立体定向脑电图(SEEG)电极植入术在药物难治性癫痫患者中的临床应用价值。方法中日友好医院神经外科自2021年10月至2022年3月采用国产睿米手术机器人辅助下SEEG电极植入术确定10例药物难治性癫痫患者的致痫灶,术中均采用骨钉Markers进行光学注册,记录注册误差、电极植入时间。术后即刻行头颅薄层CT扫描观察并发症的发生情况。术后进行植入电极的三维重建,与术前手术计划路径、靶点融合,计算电极入点误差和靶点误差。结果10例患者均通过无框架手术机器人辅助下植入SEEG电极,根据SEEG记录结果准确确定手术切除区域。10例患者的注册误差为(0.24±0.03)mm。共植入电极97枚,电极植入时间为(6.3±1.2)min。97枚电极入点误差为(1.9±1.2)mm,靶点误差为(2.1±1.2)mm。术后薄层CT扫描显示患者均未出现颅内感染和电极折断等并发症。结论国产睿米手术机器人辅助下SEEG电极植入术高效、安全,精准度高,可满足临床需要。

Objective To investigate the clinical application value of frameless stereotactic electroencephalography(SEEG)electrode implantation assisted by domestic Remebot robot in patients with drug-refractory epilepsy.Methods Ten patients with medically-refractory epilepsy,admitted to and accepted SEEG electrode implantation assisted by domestic Remebot robot in our hospital from October 2021 to March 2022,were chosen in our study.Epileptogenic focuses of these patients were determined.Bone Fiducial Markers were used for registration during surgery,and the registration error and implantation time of each electrode were recorded in detail.Thin-layer CT scan was performed immediately after surgery to observe the occurrence of complications.Three-dimensional reconstruction of all implanted electrodes was performed postoperatively,which was fused with the preoperative surgical planning paths and targets,and the electrode entry point error and target error were calculated.Results SEEG electrodes were implanted in all 10 patients with the assistance of frameless surgical robot,and the resection areas were accurately determined according to the results of SEEG records.The registered error of these 10 patients was(0.24±0.03)mm.A total of 97 SEEG electrodes were implanted,and the average effective implantation time of each electrode was(6.3±1.2)min.After the fusion of three-dimensional electrode reconstruction with preoperative surgical plan,the mean entry point error of 97 electrodes was(1.9±1.2)mm,and the mean target error was(2.1±1.2)mm.Immediate postoperative head CT showed that none of the 10 patients had surgical complications such as intracranial hemorrhage or severe pneumoencephalos.Conclusion The SEEG electrode implantation assisted by Remebot frameless robot is safe,accurate,and effective,which can meet the clinical needs.