Related Experiment Video
Updated: Feb 13, 2026
Robotic-Guided Stereoelectroencephalography for Invasive Epilepsy Monitoring
Published on: June 13, 2025
Stereoelectroencephalography-Guided Laser Ablations in Patients With Neocortical Pharmacoresistant Focal Epilepsy:
Louis Ross1, Ahsan M Naduvil2, Juan C Bulacio2
1Department of Neurosurgery, Cleveland Clinic, Ohio.
Background:
Laser ablation surgery has had encouraging results in the treatment of multiple intracranial diseases including primary and metastatic brain tumors, radiation necrosis, and epilepsy. The use of the stereoelectroencephalography (SEEG) method in combination with laser thermocoagulation therapy with the goal of modulating epileptic networks in patients with neocortical nonlesional phamacoresistant epilepsy has not been previously described.
Objective:
To describe the novel methodological and conceptual aspects related to SEEG-guided laser ablations in patients with magnetic resonance imaging (MRI)-negative pharmacoresistant neocortical focal epilepsy.
Methods:
Guided by previous SEEG intracranial data, a laser ablation probe was inserted by using a robotic guidance device in a 17-yr-old medically refractory epilepsy patient with difficult to localize seizures and nonlesional MRI. The laser applicator position was confirmed by MRI, targeting the left mesial rostral superior frontal gyrus. The ablation was performed under multiplanar digital imaging views and real-time thermal imaging and treatment estimates in each plane. A postablation MRI (contrasted T1 sequence) confirmed the ablation's location and size.
Results:
The entire procedure was achieved in approximately 100 min. The actual ablation was performed in less than 3 min. Approximately, additional 30 min preoperatively were used for positioning and robot registration. Precise placement of laser application (in comparison with preplanned trajectories) was achieved using the robotic guidance and confirmed by the intraoperative magnetic resonance images. No complications were reported. The patient has been seizure-free since surgery. The follow-up period is 20 mo. Two additional patients, treated with similar methodology, are also described.
Conclusion:
The preliminary experience with the described method shows the feasibility of a unique combination of the SEEG methodology with laser thermocoagulation in patients with neocortical MRI-negative pharmacoresistant focal epilepsy.
Insights
Stereoelectroencephalography (SEEG)-guided laser ablation is a novel treatment for drug-resistant epilepsy. This minimally invasive technique precisely targets brain networks, offering a new option for patients with difficult-to-localize seizures.
Area of Science:
- Neurosurgery
- Epileptology
- Medical Technology
Background:
- Laser ablation surgery shows promise for intracranial diseases like brain tumors and epilepsy.
- Stereoelectroencephalography (SEEG) combined with laser thermocoagulation for epilepsy has not been previously documented.
- Pharmacoresistant neocortical focal epilepsy presents challenges in localization and treatment.
Purpose of the Study:
- To detail the methodology and concepts of SEEG-guided laser ablation.
- To address treatment for MRI-negative pharmacoresistant neocortical focal epilepsy.
- To introduce a novel approach for modulating epileptic networks.
Main Methods:
- Robotic guidance system used for precise laser probe insertion, guided by SEEG data.
- Targeting of the left mesial rostral superior frontal gyrus in a patient with refractory epilepsy.
- Real-time thermal imaging and multiplanar digital views used during ablation, with MRI confirmation.
Main Results:
- Procedure completed in approximately 100 minutes, with actual ablation under 3 minutes.
- Robotic guidance and intraoperative MRI ensured precise laser application.
- The patient achieved seizure freedom for 20 months post-procedure, with no reported complications.
Conclusions:
- This preliminary study demonstrates the feasibility of SEEG-guided laser thermocoagulation.
- The technique is suitable for neocortical MRI-negative pharmacoresistant focal epilepsy.
- This novel combination offers a promising therapeutic option for refractory epilepsy.
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