Stereo-Electro-encéfalo-Graphy (EEG) com auxílio robótico na avaliação pré-cirúrgica de Medicina de Epilepsia Refratária: A Nota Técnica
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
EEG é um método e técnica que é usada para a gravação precisa, invasivo da atividade de apreensão através de três gravações tridimensionais. Em pacientes com epilepsia que são considerados candidatos adequados para gravações invasoras, a decisão é feita para monitorar entre as grades subdurais contra EEG. neuromonitoring invasivo para epilepsia é perseguido em pacientes com complexo de epilepsia, refratária. O objetivo da monitorização invasiva é oferecer cirurgia de ressecção com a esperança de permitir a liberdade de apreensão. vantagens de Seeg incluem o acesso a estruturas corticais profundas, a capacidade de localizar a zona epileptogênica (EZ) quando grades subdurais não conseguiram fazê-lo, e em pacientes com não-lesional epilepsias extra-temporais. Neste artigo, apresentamos um panorama histórico sucinto do EEG e informar sobre a nossa experiência com estereotaxia sob robótico. Um passo imperativo da inserção EEG está a planear as trajectórias de eléctrodos. A fim de registrar de forma mais eficazatividade ictal via trajectórias Seeg deve ser planejada com base em uma hipótese de que a atividade de apreensão é originário da zona epileptogênica presumida (EZ). A hipótese EZ é baseado em um exame pré-operatório padronizado incluindo monitoramento de vídeo-EEG, MRI (ressonância magnética), PET (tomografia por emissão de pósitrons), SPECT ictal (emissão de fóton único tomografia computadorizada) e avaliação neuropsicológica. Usando um EZ suspeita, eletrodos de EEG pode ser colocado minimamente invasiva ainda manter a exatidão e precisão. Os resultados clínicos mostraram a capacidade de localizar a EZ em 78% dos difíceis de localizar pacientes epilépticos 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
Aqui é apresentada a técnica de inserção EEG utilizando assistência estereotáxica robótico. Enquanto EEG foi originalmente descrita usando outros métodos de estereotaxia baseada em quadros, EEG assistida por robô oferece não só a segurança semelhante, mas superior precisão e eficiência. A literatura relata sucesso em localizar a EZ em mais de 76% dos casos, o que é solidarizar com outros estudos anteriores utilizando técnicas alternativas. 6,13,.
Como com qualquer …
Disclosures
The authors have nothing to disclose.
Acknowledgements
Os autores não têm confirmações.
References
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