Robotic-Guided Stereoelectroencephalography for Refractory Epilepsy: Technique and Nuances

Area of Science:

• Neurosurgery
• Epileptology
• Robotic Surgery

Background:

• Stereoelectroencephalography (SEEG) is crucial for epilepsy surgery, aiding in epileptogenic zone localization.
• It's essential for drug-refractory epilepsy, particularly in nonlesional cases or when imaging and clinical findings conflict.

Purpose of the Study:

• To detail the technique and operative considerations for robotic SEEG electrode placement.
• To evaluate the efficacy of robotic-guided SEEG in a challenging epilepsy case.

Main Methods:

• A 28-year-old female with epilepsy since age 15 presented with complex seizures.
• Investigations indicated bilateral temporal seizure origin.
• Robotic SEEG was performed for precise localization.

Main Results:

• SEEG identified seizure origin in the left amygdala and anterior temporal neocortex.
• The patient underwent successful left anterior temporal lobectomy and amygdalectomy.
• Histopathology confirmed focal cortical dysplasia (FCD type Ib).
• At 1-year follow-up, the patient was seizure-free (ILAE Class 1).

Conclusions:

• Robotic-guided SEEG is a safe and accurate method for evaluating complex epilepsy.
• This approach is particularly beneficial for MRI-negative epilepsy cases.
• Successful surgical outcomes can be achieved with precise SEEG localization.