Stereo-Electro-encefalo-grafia (SEEG) con assistenza robotica nel prechirurgica valutazione del medico refrattari Epilessia: una Nota Tecnica
Summary
Stereo-electroencephalography (SEEG) aids in localization of epileptogenic zones, however, remains relatively underutilized in the United States. The goal of this abstract is to provide a brief introduction to the technique of SEEG and further a detailed technique of using robotic assistance in the placement of SEEG electrodes.
Abstract
SEEG è un metodo e la tecnica che viene utilizzato per un accurato, registrazione invasiva di attività convulsiva tramite tre registrazioni tridimensionali. In pazienti con epilessia, che sono considerati candidati appropriati per le registrazioni invasive, la decisione di monitorare viene fatta tra le griglie subdurali contro SEEG. neuromonitoring invasiva per l'epilessia viene perseguita in pazienti affetti da complesse, epilessia medicalmente refrattaria. L'obiettivo del monitoraggio invasivo è quello di offrire la chirurgia resettiva con la speranza di permettere la libertà di sequestro. I vantaggi di SEEG includono l'accesso a strutture corticali profonde, la capacità di localizzare la zona epilettogena (EZ) quando le griglie subdurali non sono riusciti a farlo, e nei pazienti con non-lesionali epilessie extra-temporali. In questo manoscritto, vi presentiamo una panoramica storica succinta del SEEG e riportiamo alla nostra esperienza con stereotassi frameless in robotica. Un passo fondamentale di inserimento SEEG sta progettando le traiettorie degli elettrodi. Per registrare più efficaceattività ictale via traiettorie SEEG dovrebbe essere pianificata sulla base di una ipotesi di cui l'attività di sequestro ha origine la zona epilettogena presunta (EZ). L'ipotesi EZ si basa su una valutazione preoperatoria standardizzata tra cui monitoraggio video-EEG, MRI (risonanza magnetica), PET (tomografia ad emissione di positroni), SPECT ictale (Single-emissione di fotoni tomografia computerizzata), e la valutazione neuropsicologica. Utilizzando un EZ sospetto, elettrodi Seeg possono essere posizionati minimamente invasivo ancora mantenere l'accuratezza e precisione. I risultati clinici hanno mostrato la capacità di localizzare la EZ nel 78% dei difficili da localizzare pazienti epilettici. 1
Introduction
In medically refractory epilepsy there are many non-invasive pre-surgical tools (scalp EEG., magnetic resonance imaging (MRI), functional MRI, single photon emission computed tomography, positron emission topography, and magnetoencephalography). If these non-invasive evaluations fail to sufficiently localize or define the epileptic zone (EZ) then invasive recording may be indicated. Currently, subdural grids or Stereo-electro-encephalo-graphy (SEEG) are the two most prevalent methods of invasive monitoring. SEEG was originally developed in France in the 1950’s by Jean Talairach and Jean Bancaud; recently it has mostly been used for invasive monitoring of refractory epilepsy patients in France.2-4 SEEG is the consists of stereotactically inserting intracerebral electrodes into the brain parenchyma to record brain electrical activity for an extended period of time. With the intracerebral electrical recordings many patients are able to have their EZ defined to allow for surgical resection.
Despite this long history of success SEEG remains relatively rarely used for invasive recording in America. However, SEEG does offer several significant advantages; SEEG allows for 1) recording of deep structures, 2) bihemispheric recordings, 3) another recording option if subdural grids failed, and 4) mapping of epileptic networks in three dimensions, mainly in patients where non-lesional extra-temporal epilepsy is suspected.5-7 All of these benefits are achieved without requiring a large craniotomy. A recent technologic advance in SEEG surgery is the used of robotic guidance. This sophisticated development allows for improved operative times but safer and more accurate surgical implantation of electrodes.Recently published literature reviews the results of using two different techniques for SEEG insertion; a more traditional method utilizing stereotactic frames and a newer technique using robotic assistante for SEEG insertion.1, 8,15 the results were similarly successful with each method.
With the advent of improved robotic assistance, the SEEG insertion technique has resulted in improved operative times. The robotic system is classified as a supervisory controlled system which means the surgeon plans the operation off line and implicitly specifies the motion the robot must follow to perform the operation.9 The robotic assist results in expedient transitions from one trajectory to the next for the placement of each intracranial electrode.
Protocol
Representative Results
Discussion
Qui viene presentata la tecnica di inserimento SEEG utilizzando robotico assistenza stereotassica. Mentre SEEG è stato originariamente descritto utilizzando altri metodi di Stereotaxis basati telaio, assistita da robot SEEG offre non solo la sicurezza, ma simile precisione superiore ed efficienza. Il successo riportato in letteratura a localizzare l'EZ in oltre il 76% dei casi, che è commiserare con altri studi precedenti utilizzando tecniche alternative. 6,13,.
Come con qua…
Disclosures
The authors have nothing to disclose.
Acknowledgements
Gli autori non hanno riconoscimenti.
References
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