Stereo-electro-encéfalo-Grafía (SEEG) Con la asistencia robótica en la evaluación prequirúrgica de la epilepsia refractaria Médica: Una 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
SEEG es un método y técnica que se utiliza para el registro preciso, invasor de la actividad de ataques a través de tres grabaciones dimensionales. En los pacientes con epilepsia que son considerados candidatos adecuados para las grabaciones invasoras, se tomó la decisión de seguir entre las rejillas subdurales frente SEEG. neuromonitorización invasivo para la epilepsia es perseguido en pacientes con epilepsia compleja, resistente a fármacos. El objetivo de la monitorización invasiva es ofrecer cirugía de resección con la esperanza de permitir la ausencia de crisis. ventajas de SEEG incluyen el acceso a las estructuras profundas de la corteza, la capacidad de localizar la zona epileptógena (EZ) Cuando las redes se han subdurales no lo hizo, y en pacientes con epilepsias no lesional extra-temporales. En este manuscrito, presentamos una visión histórica sucinta de la SEEG e informamos en nuestra experiencia con estereotaxia sin marco en virtud de robótica. Un paso imperativo de inserción SEEG es la planificación de las trayectorias de los electrodos. Con el fin de registrar con mayor eficaciala actividad ictal a través de trayectorias SEEG debe planificarse en base a una hipótesis de que la actividad convulsiva se origina la zona epileptógena presunta (EZ). La hipótesis EZ se basa en un estudio preoperatorio estandarizado incluida la vigilancia de vídeo-EEG, RM (resonancia magnética), PET (tomografía por emisión de positrones), SPECT ictal (de fotón único tomografía computarizada por emisión), y la evaluación neuropsicológica. El uso de un sospechoso EZ, los electrodos se pueden colocar SEEG mínimamente invasiva sin embargo, mantener la exactitud y precisión. Los resultados clínicos mostraron la capacidad de localizar el EZ en el 78% de difícil 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
A continuación se presenta la técnica de inserción SEEG utilizar la asistencia robótica estereotáxica. Mientras SEEG fue descrito originalmente usando otros métodos de estereotaxia basados en cuadros, asistida por robot SEEG ofrece no sólo la seguridad similar pero una precisión superior y la eficiencia. El éxito reportes de la literatura en la localización de la EZ en más del 76% de los casos, que es compadecerse con otros estudios anteriores utilizando técnicas alternativas. 6,13,.
<p …Disclosures
The authors have nothing to disclose.
Acknowledgements
Los autores no tienen reconocimientos.
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