Accuracy and Workflow Improvements for Responsive Neurostimulation Hippocampal Depth Electrode Placement Using Robotic Stereotaxy
Background: Robotic stereotaxy is increasingly common in epilepsy surgery for the implantation of stereo-electroencephalography (sEEG) electrodes for intracranial seizure monitoring. The use of robots is also gaining popularity for permanent stereotactic lead implantation applications such as in dee...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2020-12-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2020.590825/full |
| _version_ | 1818562711779278848 |
|---|---|
| author | Patrick J. Karas Nisha Giridharan Jeffrey M. Treiber Marc A. Prablek A. Basit Khan Ben Shofty Vaishnav Krishnan Jennifer Chu Paul C. Van Ness Atul Maheshwari Zulfi Haneef Jay R. Gavvala Sameer A. Sheth |
| author_facet | Patrick J. Karas Nisha Giridharan Jeffrey M. Treiber Marc A. Prablek A. Basit Khan Ben Shofty Vaishnav Krishnan Jennifer Chu Paul C. Van Ness Atul Maheshwari Zulfi Haneef Jay R. Gavvala Sameer A. Sheth |
| author_sort | Patrick J. Karas |
| collection | DOAJ |
| description | Background: Robotic stereotaxy is increasingly common in epilepsy surgery for the implantation of stereo-electroencephalography (sEEG) electrodes for intracranial seizure monitoring. The use of robots is also gaining popularity for permanent stereotactic lead implantation applications such as in deep brain stimulation and responsive neurostimulation (RNS) procedures.Objective: We describe the evolution of our robotic stereotactic implantation technique for placement of occipital-approach hippocampal RNS depth leads.Methods: We performed a retrospective review of 10 consecutive patients who underwent robotic RNS hippocampal depth electrode implantation. Accuracy of depth lead implantation was measured by registering intraoperative post-implantation fluoroscopic CT images and post-operative CT scans with the stereotactic plan to measure implantation accuracy. Seizure data were also collected from the RNS devices and analyzed to obtain initial seizure control outcome estimates.Results: Ten patients underwent occipital-approach hippocampal RNS depth electrode placement for medically refractory epilepsy. A total of 18 depth electrodes were included in the analysis. Six patients (10 electrodes) were implanted in the supine position, with mean target radial error of 1.9 ± 0.9 mm (mean ± SD). Four patients (8 electrodes) were implanted in the prone position, with mean radial error of 0.8 ± 0.3 mm. The radial error was significantly smaller when electrodes were implanted in the prone position compared to the supine position (p = 0.002). Early results (median follow-up time 7.4 months) demonstrate mean seizure frequency reduction of 26% (n = 8), with 37.5% achieving ≥50% reduction in seizure frequency as measured by RNS long episode counts.Conclusion: Prone positioning for robotic implantation of occipital-approach hippocampal RNS depth electrodes led to lower radial target error compared to supine positioning. The robotic platform offers a number of workflow advantages over traditional frame-based approaches, including parallel rather than serial operation in a bilateral case, decreased concern regarding human error in setting frame coordinates, and surgeon comfort. |
| first_indexed | 2024-12-14T01:07:21Z |
| format | Article |
| id | doaj.art-5d64e09c13af4a25911964f570fd4523 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-14T01:07:21Z |
| publishDate | 2020-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-5d64e09c13af4a25911964f570fd45232022-12-21T23:22:55ZengFrontiers Media S.A.Frontiers in Neurology1664-22952020-12-011110.3389/fneur.2020.590825590825Accuracy and Workflow Improvements for Responsive Neurostimulation Hippocampal Depth Electrode Placement Using Robotic StereotaxyPatrick J. Karas0Nisha Giridharan1Jeffrey M. Treiber2Marc A. Prablek3A. Basit Khan4Ben Shofty5Vaishnav Krishnan6Jennifer Chu7Paul C. Van Ness8Atul Maheshwari9Zulfi Haneef10Jay R. Gavvala11Sameer A. Sheth12Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United StatesDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX, United StatesDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX, United StatesDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX, United StatesDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX, United StatesDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX, United StatesDepartment of Neurology, Comprehensive Epilepsy Center, Baylor College of Medicine, Houston, TX, United StatesDepartment of Neurology, Comprehensive Epilepsy Center, Baylor College of Medicine, Houston, TX, United StatesDepartment of Neurology, Comprehensive Epilepsy Center, Baylor College of Medicine, Houston, TX, United StatesDepartment of Neurology, Comprehensive Epilepsy Center, Baylor College of Medicine, Houston, TX, United StatesDepartment of Neurology, Comprehensive Epilepsy Center, Baylor College of Medicine, Houston, TX, United StatesDepartment of Neurology, Comprehensive Epilepsy Center, Baylor College of Medicine, Houston, TX, United StatesDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX, United StatesBackground: Robotic stereotaxy is increasingly common in epilepsy surgery for the implantation of stereo-electroencephalography (sEEG) electrodes for intracranial seizure monitoring. The use of robots is also gaining popularity for permanent stereotactic lead implantation applications such as in deep brain stimulation and responsive neurostimulation (RNS) procedures.Objective: We describe the evolution of our robotic stereotactic implantation technique for placement of occipital-approach hippocampal RNS depth leads.Methods: We performed a retrospective review of 10 consecutive patients who underwent robotic RNS hippocampal depth electrode implantation. Accuracy of depth lead implantation was measured by registering intraoperative post-implantation fluoroscopic CT images and post-operative CT scans with the stereotactic plan to measure implantation accuracy. Seizure data were also collected from the RNS devices and analyzed to obtain initial seizure control outcome estimates.Results: Ten patients underwent occipital-approach hippocampal RNS depth electrode placement for medically refractory epilepsy. A total of 18 depth electrodes were included in the analysis. Six patients (10 electrodes) were implanted in the supine position, with mean target radial error of 1.9 ± 0.9 mm (mean ± SD). Four patients (8 electrodes) were implanted in the prone position, with mean radial error of 0.8 ± 0.3 mm. The radial error was significantly smaller when electrodes were implanted in the prone position compared to the supine position (p = 0.002). Early results (median follow-up time 7.4 months) demonstrate mean seizure frequency reduction of 26% (n = 8), with 37.5% achieving ≥50% reduction in seizure frequency as measured by RNS long episode counts.Conclusion: Prone positioning for robotic implantation of occipital-approach hippocampal RNS depth electrodes led to lower radial target error compared to supine positioning. The robotic platform offers a number of workflow advantages over traditional frame-based approaches, including parallel rather than serial operation in a bilateral case, decreased concern regarding human error in setting frame coordinates, and surgeon comfort.https://www.frontiersin.org/articles/10.3389/fneur.2020.590825/fullhippocampal depth electroderobotic stereotaxyresponsive neurostimulation (RNS)RNS workflowrobotic stereotaxy accuracyNeuroPace |
| spellingShingle | Patrick J. Karas Nisha Giridharan Jeffrey M. Treiber Marc A. Prablek A. Basit Khan Ben Shofty Vaishnav Krishnan Jennifer Chu Paul C. Van Ness Atul Maheshwari Zulfi Haneef Jay R. Gavvala Sameer A. Sheth Accuracy and Workflow Improvements for Responsive Neurostimulation Hippocampal Depth Electrode Placement Using Robotic Stereotaxy Frontiers in Neurology hippocampal depth electrode robotic stereotaxy responsive neurostimulation (RNS) RNS workflow robotic stereotaxy accuracy NeuroPace |
| title | Accuracy and Workflow Improvements for Responsive Neurostimulation Hippocampal Depth Electrode Placement Using Robotic Stereotaxy |
| title_full | Accuracy and Workflow Improvements for Responsive Neurostimulation Hippocampal Depth Electrode Placement Using Robotic Stereotaxy |
| title_fullStr | Accuracy and Workflow Improvements for Responsive Neurostimulation Hippocampal Depth Electrode Placement Using Robotic Stereotaxy |
| title_full_unstemmed | Accuracy and Workflow Improvements for Responsive Neurostimulation Hippocampal Depth Electrode Placement Using Robotic Stereotaxy |
| title_short | Accuracy and Workflow Improvements for Responsive Neurostimulation Hippocampal Depth Electrode Placement Using Robotic Stereotaxy |
| title_sort | accuracy and workflow improvements for responsive neurostimulation hippocampal depth electrode placement using robotic stereotaxy |
| topic | hippocampal depth electrode robotic stereotaxy responsive neurostimulation (RNS) RNS workflow robotic stereotaxy accuracy NeuroPace |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2020.590825/full |
| work_keys_str_mv | AT patrickjkaras accuracyandworkflowimprovementsforresponsiveneurostimulationhippocampaldepthelectrodeplacementusingroboticstereotaxy AT nishagiridharan accuracyandworkflowimprovementsforresponsiveneurostimulationhippocampaldepthelectrodeplacementusingroboticstereotaxy AT jeffreymtreiber accuracyandworkflowimprovementsforresponsiveneurostimulationhippocampaldepthelectrodeplacementusingroboticstereotaxy AT marcaprablek accuracyandworkflowimprovementsforresponsiveneurostimulationhippocampaldepthelectrodeplacementusingroboticstereotaxy AT abasitkhan accuracyandworkflowimprovementsforresponsiveneurostimulationhippocampaldepthelectrodeplacementusingroboticstereotaxy AT benshofty accuracyandworkflowimprovementsforresponsiveneurostimulationhippocampaldepthelectrodeplacementusingroboticstereotaxy AT vaishnavkrishnan accuracyandworkflowimprovementsforresponsiveneurostimulationhippocampaldepthelectrodeplacementusingroboticstereotaxy AT jenniferchu accuracyandworkflowimprovementsforresponsiveneurostimulationhippocampaldepthelectrodeplacementusingroboticstereotaxy AT paulcvanness accuracyandworkflowimprovementsforresponsiveneurostimulationhippocampaldepthelectrodeplacementusingroboticstereotaxy AT atulmaheshwari accuracyandworkflowimprovementsforresponsiveneurostimulationhippocampaldepthelectrodeplacementusingroboticstereotaxy AT zulfihaneef accuracyandworkflowimprovementsforresponsiveneurostimulationhippocampaldepthelectrodeplacementusingroboticstereotaxy AT jayrgavvala accuracyandworkflowimprovementsforresponsiveneurostimulationhippocampaldepthelectrodeplacementusingroboticstereotaxy AT sameerasheth accuracyandworkflowimprovementsforresponsiveneurostimulationhippocampaldepthelectrodeplacementusingroboticstereotaxy |