Robotic-Guided Stereoelectroencephalography for Invasive Epilepsy Monitoring

Stereoelectroencephalography (sEEG) describes a precise method for the stereotactic implantation of intracerebral electrodes. Electrode implantation plans are made according to a localization hypothesis formulated using semiological, electrophysiological, anatomical, and imaging data. The placement of these electrodes is an invasive procedure commonly performed during pre-surgical investigation in patients with drug-resistant epilepsy who are undergoing work-up for potential surgical treatment. The technique has evolved with the inception of stereotactic robotic guidance systems, offering improved surgical efficiency while maintaining the precision and accuracy of classical frame-based stereotactic methods. Here, we present our demonstration of robotic-guided sEEG, reviewing the principles of patient positioning, registration, and safe electrode placement. The goal of the protocol is to improve the efficiency of the technique, especially in circumstances where numerous electrodes are being implanted, while maintaining the precision, accuracy, and safety of classical frame-based techniques. This article will serve as a step-by-step guide for the general technique, as well as highlight a few key safety considerations and surgical nuances.