A new tool for touch-free patient registration for robot-assisted intracranial surgery: application accuracy from a phantom study and a retrospective surgical series

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The purpose of this study was to compare the accuracy of Neurolocate frameless registration system and frame-based registration for robotic stereoelectroencephalography (SEEG).</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors performed a 40-trajectory phantom laboratory study and a 127-trajectory retrospective analysis of a surgical series. The laboratory study was aimed at testing the noninferiority of the Neurolocate system. The analysis of the surgical series compared Neurolocate-based SEEG implantations with a frame-based historical control group.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The mean localization errors (LE) ± standard deviations (SD) for Neurolocate-based and frame-based trajectories were 0.67 ± 0.29 mm and 0.76 ± 0.34 mm, respectively, in the phantom study (p = 0.35). The median entry point LE was 0.59 mm (interquartile range [IQR] 0.25–0.88 mm) for Neurolocate-registration–based trajectories and 0.78 mm (IQR 0.49–1.08 mm) for frame-registration–based trajectories (p = 0.00002) in the clinical study. The median target point LE was 1.49 mm (IQR 1.06–2.4 mm) for Neurolocate-registration–based trajectories and 1.77 mm (IQR 1.25–2.5 mm) for frame-registration–based trajectories in the clinical study. All the surgical procedures were successful and uneventful.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The results of the phantom study demonstrate the noninferiority of Neurolocate frameless registration. The results of the retrospective surgical series analysis suggest that Neurolocate-based procedures can be more accurate than the frame-based ones. The safety profile of Neurolocate-based registration should be similar to that of frame-based registration. The Neurolocate system is comfortable, noninvasive, easy to use, and potentially faster than other registration devices.</jats:p></jats:sec>

Techniques for placement of stereotactic electroencephalographic depth electrodes: Comparison of implantation and tracking accuracies in a cadaveric human study

“…More recently, the method has gained popularity in centers outside Europe, earning worldwide clinical application . It has been demonstrated that the SEEG methodology enables precise recordings from deep cortical and subcortical structures, in multiple noncontiguous lobes, allowing bihemispheric explorations while avoiding the need for large craniotomies . One of the main advantages of the SEEG method is the ability to achieve superior implantation accuracy in comparison to other methods of invasive monitoring, without direct visualization of the cerebral cortex via an open craniotomy.…”

“…7,8 It has been demonstrated that the SEEG methodology enables precise recordings from deep cortical and subcortical structures, in multiple noncontiguous lobes, allowing bihemispheric explorations while avoiding the need for large craniotomies. [9][10][11][12][13][14][15] One of the main advantages of the SEEG method is the ability to achieve superior implantation accuracy in comparison to other methods of invasive monitoring, without direct visualization of the cerebral cortex via an open craniotomy. This is in part related to (1) the applied stereotactic guiding device, (2) the type of stereotactic registration, and (3) the depth electrode implantation technique.…”

Brain biopsy performed with the RONNA G3 system: a case study on using a novel robotic navigation device for stereotactic neurosurgery

“…In frameless stereotaxy effects from brain shift, drill bending, image‐to‐patient registration techniques and differences in patient position make a large contribution to the overall accuracy of the application. Some of these errors can be reduced by intraoperative imaging. Furthermore, in their study, Mascott et al .…”

“…23 In frameless stereotaxy effects from brain shift, drill bending, image-to-patient registration techniques and differences in patient position 24 make a large contribution to the overall accuracy of the application. Some of these errors can be reduced by intraoperative imaging 4,5,25 . Furthermore, in their study, Mascott et al have reported that only implanted cranial fiducials have a statistically significant accuracy advantage over other registration techniques in frameless stereotaxy.…”

Updated review: drug-resistant epilepsy and presurgical evaluation of epilepsy surgery

“…61 Other centres have incorporated stereo EEG into a neurorobotic surgical system with comparable results. 62,63 High-frequency oscillations are a potential marker for epileptogenicity and a predictive factor for positive epilepsy surgery outcomes. 64 A meta-analysis has shown a small but significant relationship between the removal of the highfrequency oscillation-generating brain region and favourable outcomes.…”