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Frameless robot-assisted stereoelectroencephalography for refractory epilepsy in pediatric patients: accuracy, usefulness, and technical issues.
Acta Neurochir (Wien) ; 160(12): 2489-2500, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30413938
ABSTRACT

BACKGROUND:

Stereoelectroencephalography (SEEG) is an effective technique to help to locate and to delimit the epileptogenic area and/or to define relationships with functional cortical areas. We intend to describe the surgical technique and verify the accuracy, safety, and effectiveness of robot-assisted SEEG in a newly created SEEG program in a pediatric center. We focus on the technical difficulties encountered at the early stages of this program.

METHODS:

We prospectively collected SEEG indication, intraoperative events, accuracy calculated by fusion of postoperative CT with preoperative planning, complications, and usefulness of SEEG in terms of answering preimplantation hypothesis.

RESULTS:

Fourteen patients between the ages of 5 and 18 years old (mean 10 years) with drug-resistant epilepsy were operated on between April 2016 and April 2018. One hundred sixty-four electrodes were implanted in total. The median entry point localization error (EPLE) was 1.57 mm (1-2.25 mm) and the median target point localization error (TPLE) was 1.77 mm (1.2-2.6 mm). We recorded seven intraoperative technical issues. Two patients suffered complications: meningitis without demonstrated germ in one patient and a right frontal hematoma in the other. In all cases, the SEEG was useful for the therapeutic decision-making.

CONCLUSION:

SEEG has been useful for decision-making in all our pediatric patients. The robotic arm is an accurate tool for the insertion of the deep electrodes. Nevertheless, it is an invasive technique not risk-free and many problems can appear at the beginning of a robotic arm-assisted SEEG program that must be taken into account beforehand.
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Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Robótica / Técnicas Estereotáxicas / Eletroencefalografia / Epilepsia Resistente a Medicamentos Aspecto clínico: Etiologia Limite: Adolescente / Criança / Criança, pré-escolar / Feminino / Humanos / Masculino Idioma: Inglês Revista: Acta Neurochir (Wien) Ano de publicação: 2018 Tipo de documento: Artigo País de afiliação: Espanha