Effective accuracy of stereoelectroencephalography: robotic 3D versus Talairach orthogonal approaches

Abstract

OBJECTIVEStereoelectroencephalography (SEEG) was first developed in the 1950s by Jean Talairach using 2D angiography and a frame-based, orthogonal approach through a metallic grid. Since then, various other frame-based and frameless techniques have been described. In this study the authors sought to compare the traditional orthogonal Talairach 2D angiographic approach with a frame-based 3D robotic procedure that included 3D angiographic interoperative imaging guidance. MRI was used for both procedures during surgery, but MRI preplanning was done only in the robotic 3D technique.METHODSAll study patients suffered from drug-resistant focal epilepsy and were treated at the same center by the same neurosurgical team. Fifty patients who underwent the 3D robotic procedure were compared to the same number of historical controls who had previously been successfully treated with the Talairach orthogonal procedure. The effectiveness and absolute accuracy, as well as safety, of the two procedures were compared. Moreover, in the 3D robotic group, the reliability of the preoperative MRI to avoid vascular structures was evaluated by studying the rate of trajectory modification following the coregistration of the intraoperative 3D angiographic data onto the preoperative MRI-based trajectory plans.RESULTSEffective accuracy (96.5% vs 13.7%) and absolute accuracy (1.15 mm vs 4.00 mm) were significantly higher in the 3D robotic group than in the Talairach orthogonal group. Both procedures showed excellent safety results (no major complications). The rate of electrode modification after 3D angiography was 43.8%, and it was highest for frontal and insular locations.CONCLUSIONSThe frame-based, 3D angiographic, robotic procedure described here provided better accuracy for SEEG implantations than the traditional Talairach approach. This study also highlights the potential safety advantage of trajectory planning using intraoperative frame-based 3D angiography over preoperative MRI alone.

Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC)

“…To be appropriate for RF-TC the electrode needs to reach the targeted anatomical structure with a good geometric accuracy in order to allow safe coagulations in rich vascular environments. These two aspects can be assessed through a common measure called the effective accuracy [33]. Very few studies provide comparison between SEEG techniques, but the use of a stereotactic-frame, a surgical robot, and a per-operative angiography (specifically compared to pre-operative angio-MRI) seems to be associated with a better effective accuracy [33,34].…”

Indications, Techniques, and Outcomes of Robot-Assisted Insular Stereo-Electro-Encephalography: A Review

“…Robot assistance made oblique trajectories much easier due to robot reliability, versatility (multiple movement axes), and insertion-axis rigidity (30). Several groups have published their experience with frame-based robot-assisted methods (31)(32)(33)(34), which have proven to be safe and accurate. Recently, frameless techniques have emerged in order to gain time without compromising accuracy.…”

Refining Planning for Stereoelectroencephalography: A Prospective Validation of Spatial Priors for Computer-Assisted Planning With Application of Dynamic Learning

“… (A) A illustrative example of an anatomy-driven multiple trajectory planning strategy ( 3 ), with the target and entry points for the trajectory specified by the user. (B) The 3D segmentation of the whole brain structures outlined in the strategy and (C) the corresponding CAP trajectories optimizing for the user-defined parameters.…”

“…After CAP, the user reviews each trajectory to ensure clinical feasibility and safety. The potential trajectories generated for a specific target (or entry-target pair) can be iterated through using FIGURE 1 | (A) A illustrative example of an anatomy-driven multiple trajectory planning strategy (3), with the target and entry points for the trajectory specified by the user. (B) The 3D segmentation of the whole brain structures outlined in the strategy and (C) the corresponding CAP trajectories optimizing for the user-defined parameters.…”

“…The most significant risk of this procedure is intracerebral hemorrhage, which results in significant morbidity in 2-3% of cases (1). Various surgical techniques are employed for insertion of SEEG electrodes including frame-based, frameless and robotic methods with mean target point accuracies of 2-3 mm (2,3). To maximize safety, surgeons plan SEEG trajectories to maximize distance from vasculature.…”