Background Robot-assisted stereoelectroencephalography (SEEG) may represent a simplified, precise, and safe alternative to the more traditional SEEG techniques. Objective To report our clinical experience with robotic SEEG implantation and to define its utility in the management of patients with medically refractory epilepsy. Methods The prospective observational analyses included all patients with medically refractory focal epilepsy who underwent robot-assisted stereotactic placement of depth electrodes for extraoperative brain monitoring between November 2009 and May 2013. Technical nuances of the robotic implantation technique are presented, as well as an analysis of demographics, time of planning and procedure, seizure outcome, in vivo accuracy, and procedure-related complications. Results One hundred patients underwent 101 robot-assisted SEEG procedures. Their mean age was 33.2 years. In total, 1245 depth electrodes were implanted. On average, 12.5 electrodes were implanted per patient. The time of implantation planning was 30 minutes on average (range, 15-60 minutes). The average operative time was 130 minutes (range, 45-160 minutes). In vivo accuracy (calculated in 500 trajectories) demonstrated a median entry point error of 1.2 mm (interquartile range, 0.78-1.83 mm) and a median target point error of 1.7 mm (interquartile range, 1.20-2.30 mm). Of the group of patients who underwent resective surgery (68 patients), 45 (66.2%) gained seizure freedom status. Mean follow-up was 18 months. The total complication rate was 4%. Conclusion The robotic SEEG technique and method were demonstrated to be safe, accurate, and efficient in anatomically defining the epileptogenic zone and subsequently promoting sustained seizure freedom status in patients with difficult-to-localize seizures.

Technique, Results, and Complications Related to Robot-Assisted Stereoelectroencephalography.

For the authors, the essential feature of stereotaxis is the three-dimensional representation of the entire brain, including the central gray nuclei as well as the cerebral cortex. Stereotactic neurosurgery, which in this conception might be called “global”, associates data from indirect localization (basic reference lines, proportional grid) to direct individual localization (performed by bidirectional, orthogonal teleradiography, with stereoscopy). The obtained high precision radiographic documents allow to establish the three coordinates (X, Y, Z).

Application of Stereotactic Concepts to the Surgery of Epilepsy

The results obtained with interstitial brachytherapy in thirty-six low-grade cerebral gliomas (2 pilocytic astrocytomas, 23 astrocytomas and 11 oligodendrogliomas) are reported (mean follow-up: 75 months, range 37–159). All tumours were situated in locations which did not call for surgical removal as the treatment of choice. Their volume ranged from 4 to 82 cc (m=32); the Karnofsky performance status (KPS) of the treated patients lay between 0.60 and 0.90.

Interstitial brachytherapy for low-grade cerebral gliomas: analysis of results in a series of 36 cases.

A simple approach to stereotaxic radiography, including a new method for determination of target coordinates, is described. The proposed technique may be used in combination with conventional equipment for roentgen eximinations available in X-ray departments and operating rooms; the only additional outfit needed is a coordinate frame that can be attached to the patient's head. Determination of the coordinates is easily made graphically, or from a simple equation using a pocket calculator or a mini-computer.

An approach to stereotaxic radiography

A method for the determination of stereotaxic coordinates in radiography, e.g. angiography, pneumoencephalography or digital vascular radiography, is described. A special localization frame containing radiopaque structures and scales defines a diagnostic coordinate system. This frame is fixed to the X-ray-table prior to the radiographic procedure and two projections are obtained at arbitrary angles to each other. The focus-film distances do not how to be fixed. The target coordinates are then determined either by a simple graphical procedure or with the use of a digitizing x-y-table, by a computer. With the computer method the films are placed on the digitizing table and the target and a few reference points are marked using a cursor. From the relative positions the computer calculates the coordinates. With the special head fixation system, coordinates of structures visualized in radiographic examinations can be transferred to various therapeutic or diagnostic stereotaxic devices.

A method of stereotaxic localization adopted for conventional and digital radiography.

Comparison between encephalography and ventriculography.

Stereotaxic surgery has for some years been used in the treatment of certain functional disorders of the nervous system and, more recently, of certain brain tumours shown to be practically unamenable to the usual surgical methods. Stereotaxic investigation consists in defining in space the position of a point within the cranial cavity, which is to be reached for therapeutic purposes. I t involves the solution of a fundamental anatomic problem — the accurate localization of a normal or pathologic structure. A second technical problem of constructing and using the necessary apparatus arises as a corollary of the first. Radiologie factors play a primary rôle in the method, as will be shown in this paper. We shall not deal with stereotaxic apparatus, the technique of stereometry, or the stereotaxic operation.

The roentgenologic contribution to stereotaxic investigations of the brain and its practical application in pathologic conditions.

Using a stereotactic radio method for in situ radioactive treatment of brain tumors

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Comparison between encephalography and ventriculography.

The roentgenologic contribution to stereotaxic investigations of the brain and its practical application in pathologic conditions.

Using a stereotactic radio method for in situ radioactive treatment of brain tumors