Accuracy and Workflow Improvements for Responsive Neurostimulation Hippocampal Depth Electrode Placement Using...

Area of Science:

• Neurosurgery
• Robotics
• Epilepsy Treatment

Background:

• Robotic stereotaxy is increasingly utilized in epilepsy surgery for stereo-electroencephalography (sEEG) electrode implantation.
• Robots are also gaining traction for permanent stereotactic lead implantation in deep brain stimulation and responsive neurostimulation (RNS).

Purpose of the Study:

• To describe the evolution of a robotic stereotactic implantation technique for occipital-approach hippocampal RNS depth leads.
• To evaluate the accuracy and initial efficacy of this robotic implantation technique.

Main Methods:

• Retrospective review of 10 patients undergoing robotic RNS hippocampal depth electrode implantation.
• Accuracy measured by comparing intraoperative and post-operative imaging with the stereotactic plan.
• Seizure data collected from RNS devices for outcome analysis.

Main Results:

• Prone positioning (8 electrodes) yielded significantly lower radial error (0.8 ± 0.3 mm) compared to supine positioning (10 electrodes, 1.9 ± 0.9 mm) (p=0.002).
• Early follow-up (median 7.4 months) showed a mean seizure frequency reduction of 26% in 8 patients.
• 37.5% of patients achieved ≥50% seizure reduction based on RNS device data.

Conclusions:

• Prone positioning enhances accuracy for robotic implantation of occipital-approach hippocampal RNS depth electrodes.
• The robotic platform offers workflow advantages over traditional frame-based methods, including efficiency and reduced potential for human error.