How I do it: a standardized robotic workflow for image-guided stereo-electroencephalography: technical description...

Area of Science:

• Neurosurgery
• Medical Robotics
• Epilepsy Research

Background:

• Stereo-electroencephalography (SEEG) is crucial for presurgical evaluation of drug-resistant focal epilepsy.
• Robotic assistance enhances precision and standardization in SEEG electrode implantation.

Purpose of the Study:

• To describe a reproducible image-based robotic SEEG implantation protocol.
• To report institutional experience with this robotic SEEG technique.

Main Methods:

• Utilized an image-based robot-assisted SEEG technique with the Neuromate® system and intraoperative 3D imaging.
• Implemented a workflow including trajectory planning, laser registration, depth-controlled drilling, and imaging verification.

Main Results:

• Successfully implanted 952 SEEG electrodes in 68 patients, averaging 14 electrodes per patient.
• Mean robotic implantation time was 198 minutes (14.1 min/electrode) with a mean registration error of 1.7 mm.
• Reported a 4.4% rate of intracranial hemorrhage, with one symptomatic case requiring evacuation (occurred during removal, not insertion).

Conclusions:

• Image-based robot-assisted SEEG enables accurate, reproducible multi-trajectory implantation with an efficient workflow and low complication rates.
• Structured planning and intraoperative verification enhance procedural safety and standardization.