Safety and efficacy of stereoelectroencephalography using a novel robot based on the center-of-arc principle in patients with medically refractory epilepsy

Abstract

Objective: Robot-assisted stereoelectroencephalography (SEEG) allows precise electrode placement in a reduced operative time. Conventional stereotactic surgeries rely on the center-of-arc principle; however, earlier robotic systems did not adopt this methodology. A table-mounted stereotactic robot based on the center-of-arc principle and integrated with neuronavigation was recently developed. This system aims to enhance stability, usability, and working space in the operating room through a precisely controlled motion mechanism. The authors of this study evaluated the safety and efficacy of SEEG electrode implantation using this novel stereotactic robot.

Methods: In this retrospective study, the authors analyzed consecutive cases of robot-assisted SEEG electrode placement using the table-mounted arc-based robot at a single institution between April 2021 and April 2024. Only patients with at least 12 months of postoperative follow-up were eligible for inclusion. The collected data included operative time, procedure-related complications, and electrode placement accuracy, which was assessed using entry point error (EPE), target point error (TPE), radial error (RE), and depth error (DE). Epilepsy outcomes following subsequent resective surgeries were also evaluated.

Results: Among the 54 cases eligible for study inclusion, a mean of 8.0 electrodes were placed per patient. The actual electrode insertion time was a mean of 57.6 minutes, with a mean insertion time of 7.2 minutes per electrode. The mean EPE, TPE, RE, and DE were 1.21 ± 0.72, 2.03 ± 1.37, 1.06 ± 1.22, and 1.24 ± 1.13 mm, respectively. No procedure-related complications were observed. After resective surgery, 60.0% of patients attained seizure freedom at a mean follow-up of 21.4 months.

Conclusions: This study revealed that SEEG electrode placement using a novel robot system based on the center-of-arc principle with neuronavigation assistance is safe and effective. Further validation of SEEG safety and accuracy in a larger cohort is recommended.