Stereotactic depth electrode placement surgery in paediatric and adult patients with the Neuromate robotic device: Accuracy, complications and epileptological results.

OBJECTIVE: The number of patients requiring depth electrode implantation for invasive video EEG diagnostics increases in most epilepsy centres. Here we report on our institutional experience with frameless robot-assisted stereotactic placement of intracerebral depth electrodes using the Neuromate® stereotactic robot-system. METHODS: We identified all patients who had undergone robot-assisted stereotactic placement of intracerebral depth electrodes for invasive extra-operative epilepsy monitoring between September 2013 and March 2020. We studied technical (placement) and diagnostic accuracy of the robot-assisted procedure, associated surgical complications and procedural time requirements. RESULTS: We evaluated a total of 464 depth electrodes implanted in 74 patients (mean 6 per patient, range 1-12). There were 27 children and 47 adults (age range: 3.6-64.6 yrs.). The mean entry and target point errors were 1.82±1.15 and 1.98±1.05 mm. Target and entry point errors were significantly higher in paediatric vs. adult patients and for electrodes targeting the temporo-mesial region. There were no clinically relevant haemorrhages and no infectious complications. Mean time for the placement of one electrode was 37±14 min and surgery time per electrode decreased with the number of electrodes placed. 55 patients (74.3%) underwent definitive surgical treatment. 36/51 (70.1%) patients followed for >12 months or until seizure recurrence became seizure-free (ILAE I). CONCLUSION: Frameless robot-guided stereotactic placement of depth electrodes with the Neuromate® stereotactic robot-system is safe and feasible even in very young children, with good in vivo accuracy and high diagnostic precision. The surgical workflow is time-efficient and further improves with increasing numbers of implanted electrodes.

Experience with 102 Frameless Stereotactic Biopsies Using the neuromate Robotic Device.

OBJECTIVE: Stereotactic biopsy is a standard procedure in neurosurgery. In addition to or even replacing frame-based stereotaxy, some centers also use frameless imaging-based techniques and more recently robotic systems. Here we report a retrospective analysis of our experience with 102 consecutive biopsies performed in our institution using the neuromate robotic device. METHODS: Between March 2013 and April 2018, 102 robot-assisted frameless biopsies were performed in 100 consecutive patients (median age/range: 66/7-86 years, male: 64). Target lesions were deep-seated (insula, basal ganglia, thalamus, midbrain, cerebellar peduncle) in 29 (28.4%) and/or small (<15 mm) in 24 (23.5%) cases. We retrospectively analyzed the histopathologic results as well as complications and the duration of the procedures. RESULTS: A definite histologic diagnosis could be established in 94 of 102 procedures (92.2%; 94/100 patients = 94.0%), including 67 glial and glioneuronal tumors, 16 central nervous system lymphomas, 7 metastases, 1 primitive neuroectodermal tumor, and 5 cases with inflammatory or infectious disorders. There were no infectious complications. A total of 13 cases (12.7%) suffered from biopsy-related hemorrhages >10 mm; however, persistent surgery-related neurologic worsening was seen in only 3 (2.9%). The average operating time was 10 minutes for placement of the localizing device under local anesthesia and 30 minutes for the actual biopsy procedure. CONCLUSIONS: Robot-assisted fameless stereotactic biopsies using the neuromate robot are an alternative to frame-based stereotaxy with a similar diagnostic yield and comparable complication rates.

Environmental enrichment counteracts Alzheimer's neurovascular dysfunction in TgCRND8 mice.

We and others have recently demonstrated that cognitive and physical stimulation in form of environmental enrichment reduces cerebral beta-amyloid (Abeta) deposition in transgenic mouse models of Alzheimer's disease. This effect was independent from amyloid precursor protein (APP) expression or processing and rather a consequence of enhanced clearance of Abeta. However, the detailed mechanisms remain unclear. In the present study, we show that environmental enrichment in TgCRND8 mice (carrying human APP(Swedish+Indiana)) affect the neurovascular unit by increased angiogenesis and differential regulation of Abeta receptor/transporter molecules, namely up-regulation of LRP1, ApoE and A2M as well as down-regulation of RAGE so that brain to blood Abeta clearance is facilitated. These results suggest a hitherto unknown effect of environmental enrichment counteracting the vascular dysfunction in Alzheimer diseased brain.