2022 Volume 31 Issue 6 Pages 393-399
Recently, intracranial electrode implantation using a stereotactic robotic device has been gaining universal popularity in the field of stereotactic neurosurgery. Robot-assisted implantation has advantages of accuracy, decreased procedure time, and a low complication rate. However, to perform the procedure safely, it is necessary to be skilled in surgical planning and technique. Here we present a case of intracranial stereo-electroencephalography (SEEG) using ROSA-guided robotic surgery.
A 19-year-old male presented with intractable focal seizures with impaired consciousness. Brain MRI showed ischemic ulegyria in the medial right occipital lobe ; FDG-PET was suggestive of extensive abnormalities from the medial/lateral right temporal lobe to the occipital lobe. In this case, we hypothesized that the ischemic ulegyria in the medial occipital lobe was the epileptic focus. We decided to implant intracranial electrodes extensively from the occipital lobe to the temporal lobe and record SEEG to localize the epileptic focus. After loading the patient's imaging datasets into the ROSA software, seven stereotactic trajectories were selected for the electrode insertion route. To avoid hemorrhagic complications, ROSA software was used to map the optimal surgical paths for each electrode insertion. By incorporating the preoperative simulation, we efficiently performed implantation and confirmed electrode locations using ROSA software. Finally, we detected the habitual seizure and ictal discharges originating from the hippocampus on SEEG. To perform the procedure safely and quickly, it is important to accumulate tips and pitfalls to avoid complications.
