의료 내화물 간질의 수술 전 평가에서 로봇 지원으로 스테레오 전기 Encephalo-그래피로 (SEEG) : A 기술 참고
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
SEEG는 입체 녹화 통해 발작 활동의 정확한 침입 기록하는데 사용되는 방법 및 기술이다. 침략 녹음에 적합한 후보를 판단되는 간질 환자에서 모니터링 할 수있는 결정은 SEEG 대 경막 그리드 사이에 이루어집니다. 간질에 대한 침략 neuromonitoring 복잡한 의학적 내화물 간질 환자에서 추진된다. 침입 모니터링의 목표는 발작 자유를 허용하는 희망 resective 수술을 제공하는 것입니다. SEEG의 장점은 깊은 대뇌 피질의 구조에 대한 액세스는 간질 영역 경막 그리드 그렇게하지 못했다 (EZ), 비 병변 여분의 시간 간질 환자에서 지역화 할 수있는 능력을 포함한다. 이 논문에서 우리는 SEEG의 간결한 역사의 개요를 제시하고 로봇에서 틀 정위와 우리의 경험을보고하고자한다. SEEG 삽입의 필수 단계는 전극 궤도를 계획하고있다. 가장 효율적으로 기록하기 위해SEEG 궤적을 통해 발작 활동은 발작 활동이 추정 간질 존 (EZ)를 비롯 곳의 가설에 기초하여 계획하여야한다. EZ 가설은 비디오 EEG 모니터링, MRI (자기 공명 영상), PET (양전자 방출 단층 촬영), 발작 SPECT (단일 광자 방출 전산화 단층 촬영), 및 신경 정신 학적 평가를 포함하는 표준화 된 수술 후 처리에 기초한다. 의심 EZ를 사용 SEEG 전극 최소 침습적 아직 정확도와 정밀도를 유지 배치 될 수있다. 임상 결과는 간질 환자를 국산화하기 어려운의 78 %에 EZ을 지역화 할 수있는 능력을 보여 주었다. (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
여기에 로봇 정위 지원을 활용 SEEG 삽입의 기술을 제공됩니다. SEEG 원래 프레임 기반 stereotaxis의 다른 방법을 사용하여 설명되었지만, 로봇 보조 SEEG 유사한 안전하지만 우수한 정확도와 효율성뿐만 아니라 제공합니다. 다른 이전의 연구는 다른 기술을 사용하여. 6,13-을 함께 동정 인 경우 76 % 이상,에 EZ 현지화의 문헌보고 성공.
어떤 침략 두개 절차와 마찬가?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
저자는 어떤 승인이 없습니다.
References
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