sEEG for expansion of a surgical epilepsy program: Safety and efficacy in 152 consecutive cases

Miller, Christopher P.; Schatmeyer, Bryan; Landazuri, Patrick; Uysal, Utku; Nazzaro, Jules M.; Kinsman, Michael; Camarata, Paul J.; Ulloa, Carol M; Hammond, Nancy; Pearson, C. R.; Shah, Vishal; Cheng, Jennifer J.

doi:10.1002/epi4.12535

Cited by 16 publications

(21 citation statements)

References 31 publications

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“…Five studies 24 - 28 ) were excluded considering that they did not mention the use of the ROSA Ⓡ device. Thus, in the final analysis, 15 studies 10 , 17 - 21 , 29 - 37 ) were included.…”

Section: Resultsmentioning

confidence: 99%

Usefulness of Robotic Stereotactic Assistance (ROSA<sup>®</sup>) Device for Stereoelectroencephalography Electrode Implantation: A Systematic Review and Meta-analysis

KAEWBORISUTSAKUL,

CHERNOV,

YOKOSAKO

et al. 2024

Neurol. Med. Chir.(Tokyo)

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The aim of this study was to systematically review and meta-analyze the efficiency and safety of using the Robotic Stereotactic Assistance (ROSA Ⓡ ) device (Zimmer Biomet; Warsaw, IN, USA) for stereoelectroencephalography (SEEG) electrode implantation in patients with drug-resistant epilepsy. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was carried out. Overall, 855 nonduplicate relevant articles were determined, and 15 of them were selected for analysis. The benefits of the ROSA Ⓡ device use in terms of electrode placement accuracy, as well as operative time length, perioperative complications, and seizure outcomes, were evaluated. Studies that were included reported on a total of 11,257 SEEG electrode implantations. The limited number of comparative studies hindered the comprehensive evaluation of the electrode implantation accuracy. Compared with frame-based or navigation-assisted techniques, ROSA Ⓡ -assisted SEEG electrode implantation provided significant benefits for reduction of both overall operative time (mean difference [MD], −63.45 min; 95% confidence interval [CI] from −88.73 to −38.17 min; P < 0.00001) and operative time per implanted electrode (MD, −8.79 min; 95% CI from −14.37 to −3.21 min; P = 0.002). No significant differences existed in perioperative complications and seizure outcomes after the application of the ROSA Ⓡ device and other techniques for electrode implantation. To conclude, the available evidence shows that the ROSA Ⓡ device is an effective and safe surgical tool for trajectory-guided SEEG electrode implantation in patients with drug-resistant epilepsy, offering benefits for saving operative time and neither increasing the risk of perioperative complications nor negatively impacting seizure outcomes.

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“…Five studies 24 - 28 ) were excluded considering that they did not mention the use of the ROSA Ⓡ device. Thus, in the final analysis, 15 studies 10 , 17 - 21 , 29 - 37 ) were included.…”

Section: Resultsmentioning

confidence: 99%

Usefulness of Robotic Stereotactic Assistance (ROSA<sup>®</sup>) Device for Stereoelectroencephalography Electrode Implantation: A Systematic Review and Meta-analysis

KAEWBORISUTSAKUL,

CHERNOV,

YOKOSAKO

et al. 2024

Neurol. Med. Chir.(Tokyo)

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“…Complications included intracranial haemorrhage in two, retained electrodes in three and two medical complications. 18 Méreaux et al also reported 49 consecutive SEEG cases showing death in one patient because of a delayed subdural haematoma and several other complications. Transient confusion and visuospatial symptoms were seen in two patients and electrode dysfunction occurred in six electrodes (1%), including one broken electrode.…”

Section: Discussionmentioning

confidence: 96%

“…recently described 152 SEEG cases with a major complication rate of 3.94% per procedure or 0.37% per electrode. Complications included intracranial haemorrhage in two, retained electrodes in three and two medical complications 18 . Méreaux et al .…”

Section: Discussionmentioning

confidence: 99%

Stereoelectroencephalography: a review of complications and outcomes in a new Australian centre

Murray‐Douglass,

Papacostas,

Ovington

et al. 2024

Internal Medicine Journal

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BackgroundSurgical management of refractory focal epilepsy requires preoperative localisation of the epileptogenic zone (EZ). To augment noninvasive studies, stereoelectroencephalography (SEEG) is being increasingly adopted as a form of intracranial monitoring.AimsThis study aimed to determine the rate of complications for patients undergoing SEEG and to report the success of SEEG with regard to EZ detection and seizure outcome following definitive surgery.MethodsA retrospective cohort design investigated all cases of SEEG at our institution. Surgical, anaesthetic and medical complications with subsequent epilepsy surgery and seizure outcome data were extracted from medical records. Multivariate logistic regression was used to investigate the relationship between both the number of electrodes per patient and the duration of SEEG recording with the rate of complications.ResultsSixty‐four patients with 66 implantations were included. Headache was the most common complication (n = 54, 82%). There were no major surgical or medical complications. Two anaesthetic complications occurred. EZ localisation was successful in 63 cases (95%). Curative intent surgery was performed in 39 patients (59%) and 23 patients achieved an Engel class I outcome (59% of those undergoing surgery). The number of electrodes and duration of recording were not associated with complications.ConclusionsNo patients in our series experienced major surgical or medical complications and we have highlighted the challenges associated with neuroanaesthesia in SEEG. Our complication rates and seizure outcomes are equivalent to published literature indicating that this technique can be successfully established in newer centres using careful case selection. Standardised reporting of SEEG complications should be adopted.

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“…They compare our results with those of Cardinale which included 500 patients. They also reference a report by Miller et al 4 of 152 patients using a standardized method and a meta-analysis with 2624 patients. 5 Comparison of these large series with a technical report of 9 patients during an initial period of learning is simply not justifiable.…”

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confidence: 97%

In Reply: Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results

Mamelak¹

2022

Operative Neurosurgery

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To the Editor:We appreciate the letter from Dr Philipp 1 in response to our article "Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results." 2 The authors are critical of our results, indicating that they do not support our conclusions. Rather, they suggest that the Autoguide system is both unsafe and inaccurate. We respectfully disagree.Our article was written as a technical report, describing a new method, and the early modifications that we adopted. It represents our initial learning curve. This is by no means an authoritative clinical series. Despite this, Philipp et al 3 compared our findings to several large series. These are simply not valid comparisons. They compare our results with those of Cardinale which included 500 patients. They also reference a report by Miller et al 4 of 152 patients using a standardized method and a meta-analysis with 2624 patients. 5 Comparison of these large series with a technical report of 9 patients during an initial period of learning is simply not justifiable.Furthermore, their entire safety concern is based on a single hemorrhage in the first patient implanted, a case in which we acknowledge the drilling method recommended by the manufacturer was problematic. Had we chosen to exclude the first patient and only report on the subsequent 8, and we would have missed the opportunity to point out this important technical issue to other users. Rather, we would have reported a 0% complication rate, seemingly indicating that the system is the safest one every reported in the literature! This would be equally ludicrous. This is the danger of statistical inference in low sample sizes. Based on their previous publications, 6 Philipp et al should be well aware of this danger. The goal of this article was to provide technical guidance for other users to increase their accuracy and reduce rates of complications. Any other reading of this article is incorrect.Furthermore, it is likely that true stereotactic electroencephalograhy hemorrhage rates are grossly underreported. By example, the Cleveland Clinic group (included as part of the analysis reported here as proof of our low safety 5 ) has reported a per the electrode complication rate of 0.18%, and only 3 patients having any sort of hemorrhage at 2.4%. 7 However, a blinded review of their own hemorrhagic complications in 549 consecutive patients noted a true hemorrhage rate of 19.1%, of which 2 (2%) were symptomatic and a death rate of 0.2%. 8 In other words, the exact same group, looking at their own data in 2 different ways, reported a hemorrhage rate that changed from 2.4% to 19%. This does not imply that the authors are dishonest.

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sEEG for expansion of a surgical epilepsy program: Safety and efficacy in 152 consecutive cases

Cited by 16 publications

References 31 publications

Usefulness of Robotic Stereotactic Assistance (ROSA<sup>®</sup>) Device for Stereoelectroencephalography Electrode Implantation: A Systematic Review and Meta-analysis

Usefulness of Robotic Stereotactic Assistance (ROSA<sup>®</sup>) Device for Stereoelectroencephalography Electrode Implantation: A Systematic Review and Meta-analysis

Stereoelectroencephalography: a review of complications and outcomes in a new Australian centre

In Reply: Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results

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