Frameless Robot-Assisted Asleep Centromedian Thalamic Nucleus Deep Brain Stimulation Surgery in Patients with Drug-Resistant Epilepsy: Technical Description and Short-Term Clinical Results
Abstract Introduction This purpose of this work is to give a detailed description of a surgical technique for frameless robot-assisted asleep deep brain stimulation (DBS) of the centromedian thalamic nucleus (CMT) in drug-resistant epilepsy (DRE). Methods Ten consecutively enrolled patients who unde...
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| Format: | Article |
| Language: | English |
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Adis, Springer Healthcare
2023-03-01
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| Series: | Neurology and Therapy |
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| Online Access: | https://doi.org/10.1007/s40120-023-00451-2 |
| _version_ | 1827943177212919808 |
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| author | Changquan Wang Jing Hong Ziyu Mao Wenze Chen Bin Chen Wenzhen Chen Xiaolai Ye Chencheng Zhang Yong Lu Qiangqiang Liu Jiwen Xu |
| author_facet | Changquan Wang Jing Hong Ziyu Mao Wenze Chen Bin Chen Wenzhen Chen Xiaolai Ye Chencheng Zhang Yong Lu Qiangqiang Liu Jiwen Xu |
| author_sort | Changquan Wang |
| collection | DOAJ |
| description | Abstract Introduction This purpose of this work is to give a detailed description of a surgical technique for frameless robot-assisted asleep deep brain stimulation (DBS) of the centromedian thalamic nucleus (CMT) in drug-resistant epilepsy (DRE). Methods Ten consecutively enrolled patients who underwent CMT-DBS were included in the study. The FreeSurfer "Thalamic Kernel Segmentation" module and experience target coordinates were used for locating the CMT, and quantitative susceptibility mapping (QSM) images were used to check the target. The patient's head was secured with a head clip, and electrode implantation was performed with the assistance of the neurosurgical robot Sinovation®. After opening the dura, the burr hole was continuously flushed with physiological saline to stop air from entering the skull. All procedures were performed under general anesthesia without intraoperative microelectrode recording (MER). Results The mean age of the patients at surgery and onset of seizures was 22 years (range 11–41 years) and 11 years (range 1–21 years), respectively. The median duration of seizures before CMT-DBS surgery was 10 years (2–26 years). CMT was successfully segmented, and its position was verified by experience target coordinates and QSM images in all ten patients. The mean surgical time for bilateral CMT-DBS in this cohort was 165 ± 18 min. The mean pneumocephalus volume was 2 cm3. The median absolute errors in the x-, y-, and z-axes were 0.7 mm, 0.5 mm, and 0.9 mm, respectively. The median Euclidean distance (ED) and radial error (RE) was 1.3 ± 0.5 mm and 1.0 ± 0.3 mm, respectively. No significant difference was found between right- and left-sided electrodes regarding the RE nor the ED. After a mean 12-month follow-up, the average reduction in seizures was 61%, and six patients experienced a ≥ 50% reduction in seizures, including one patient who had no seizures after the operation. All patients tolerated the anesthesia operation, and no permanent or serious complications were reported. Conclusions Frameless robot-assisted asleep surgery is a precise and safe approach for placing CMT electrodes in patients with DRE, shortening the surgery time. The segmentation of the thalamic nuclei enables the precise location of the CMT, and the flow of physiological saline to seal the burr holes is a good way to reduce the influx of air. CMT-DBS is an effective method to reduce seizures. |
| first_indexed | 2024-03-13T10:11:31Z |
| format | Article |
| id | doaj.art-632278e7922b40d7bfd48b6a818dbb08 |
| institution | Directory Open Access Journal |
| issn | 2193-8253 2193-6536 |
| language | English |
| last_indexed | 2024-03-13T10:11:31Z |
| publishDate | 2023-03-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Neurology and Therapy |
| spelling | doaj.art-632278e7922b40d7bfd48b6a818dbb082023-05-21T11:30:37ZengAdis, Springer HealthcareNeurology and Therapy2193-82532193-65362023-03-0112397799310.1007/s40120-023-00451-2Frameless Robot-Assisted Asleep Centromedian Thalamic Nucleus Deep Brain Stimulation Surgery in Patients with Drug-Resistant Epilepsy: Technical Description and Short-Term Clinical ResultsChangquan Wang0Jing Hong1Ziyu Mao2Wenze Chen3Bin Chen4Wenzhen Chen5Xiaolai Ye6Chencheng Zhang7Yong Lu8Qiangqiang Liu9Jiwen Xu10Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of MedicineClinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of MedicineClinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of MedicineClinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of MedicineClinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of MedicineClinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of MedicineClinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of MedicineDepartment of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineClinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of MedicineClinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of MedicineClinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of MedicineAbstract Introduction This purpose of this work is to give a detailed description of a surgical technique for frameless robot-assisted asleep deep brain stimulation (DBS) of the centromedian thalamic nucleus (CMT) in drug-resistant epilepsy (DRE). Methods Ten consecutively enrolled patients who underwent CMT-DBS were included in the study. The FreeSurfer "Thalamic Kernel Segmentation" module and experience target coordinates were used for locating the CMT, and quantitative susceptibility mapping (QSM) images were used to check the target. The patient's head was secured with a head clip, and electrode implantation was performed with the assistance of the neurosurgical robot Sinovation®. After opening the dura, the burr hole was continuously flushed with physiological saline to stop air from entering the skull. All procedures were performed under general anesthesia without intraoperative microelectrode recording (MER). Results The mean age of the patients at surgery and onset of seizures was 22 years (range 11–41 years) and 11 years (range 1–21 years), respectively. The median duration of seizures before CMT-DBS surgery was 10 years (2–26 years). CMT was successfully segmented, and its position was verified by experience target coordinates and QSM images in all ten patients. The mean surgical time for bilateral CMT-DBS in this cohort was 165 ± 18 min. The mean pneumocephalus volume was 2 cm3. The median absolute errors in the x-, y-, and z-axes were 0.7 mm, 0.5 mm, and 0.9 mm, respectively. The median Euclidean distance (ED) and radial error (RE) was 1.3 ± 0.5 mm and 1.0 ± 0.3 mm, respectively. No significant difference was found between right- and left-sided electrodes regarding the RE nor the ED. After a mean 12-month follow-up, the average reduction in seizures was 61%, and six patients experienced a ≥ 50% reduction in seizures, including one patient who had no seizures after the operation. All patients tolerated the anesthesia operation, and no permanent or serious complications were reported. Conclusions Frameless robot-assisted asleep surgery is a precise and safe approach for placing CMT electrodes in patients with DRE, shortening the surgery time. The segmentation of the thalamic nuclei enables the precise location of the CMT, and the flow of physiological saline to seal the burr holes is a good way to reduce the influx of air. CMT-DBS is an effective method to reduce seizures.https://doi.org/10.1007/s40120-023-00451-2Centromedian thalamic nucleusDeep brain stimulationDrug-resistant epilepsyRoboticsFramelessStereotaxic techniques |
| spellingShingle | Changquan Wang Jing Hong Ziyu Mao Wenze Chen Bin Chen Wenzhen Chen Xiaolai Ye Chencheng Zhang Yong Lu Qiangqiang Liu Jiwen Xu Frameless Robot-Assisted Asleep Centromedian Thalamic Nucleus Deep Brain Stimulation Surgery in Patients with Drug-Resistant Epilepsy: Technical Description and Short-Term Clinical Results Neurology and Therapy Centromedian thalamic nucleus Deep brain stimulation Drug-resistant epilepsy Robotics Frameless Stereotaxic techniques |
| title | Frameless Robot-Assisted Asleep Centromedian Thalamic Nucleus Deep Brain Stimulation Surgery in Patients with Drug-Resistant Epilepsy: Technical Description and Short-Term Clinical Results |
| title_full | Frameless Robot-Assisted Asleep Centromedian Thalamic Nucleus Deep Brain Stimulation Surgery in Patients with Drug-Resistant Epilepsy: Technical Description and Short-Term Clinical Results |
| title_fullStr | Frameless Robot-Assisted Asleep Centromedian Thalamic Nucleus Deep Brain Stimulation Surgery in Patients with Drug-Resistant Epilepsy: Technical Description and Short-Term Clinical Results |
| title_full_unstemmed | Frameless Robot-Assisted Asleep Centromedian Thalamic Nucleus Deep Brain Stimulation Surgery in Patients with Drug-Resistant Epilepsy: Technical Description and Short-Term Clinical Results |
| title_short | Frameless Robot-Assisted Asleep Centromedian Thalamic Nucleus Deep Brain Stimulation Surgery in Patients with Drug-Resistant Epilepsy: Technical Description and Short-Term Clinical Results |
| title_sort | frameless robot assisted asleep centromedian thalamic nucleus deep brain stimulation surgery in patients with drug resistant epilepsy technical description and short term clinical results |
| topic | Centromedian thalamic nucleus Deep brain stimulation Drug-resistant epilepsy Robotics Frameless Stereotaxic techniques |
| url | https://doi.org/10.1007/s40120-023-00451-2 |
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