Abstracts

Trajectory Metric Analysis in Stereotactic Robotic-guided SEEG for Epilepsy: Laser versus Fiducial-based O-arm Registration Workflows

Abstract number : 2.463
Submission category : 9. Surgery / 9C. All Ages
Year : 2024
Submission ID : 893
Source : www.aesnet.org
Presentation date : 12/8/2024 12:00:00 AM
Published date :

Authors :
Presenting Author: Ryan Song, B.A. – Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

Akshay Sharma, M.D. – Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
Nehaw Sarmey, M.D. – Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
Stephen Harasimchuk, R. EEG T. – Cleveland Clinic
Juan Bulacio, MD – Cleveland Clinic
Richard Rammo, MD – Cleveland Clinic
William Bingaman, M.D. – Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
Demitre Serletis, MD, PhD – Cleveland Clinic

Rationale: Stereoelectroencephalography (SEEG) is an important methodology used for invasive evaluation in patients with medically refractory epilepsy. Traditionally, laser-based facial scanning has been utilized for stereotactic robotic (ROSA, Zimmer Biomet) registration at our center. More recently, however, we developed and validated a novel, noninvasive, Leksell G (Elekta) frame-based fiducial system integrated with O-arm (Medtronic, Inc) registration, as part of our SEEG procedural workflow. The goal of this project was to compare the stereotactic accuracy in SEEG electrode placement using these two approaches.


Methods: Registration error (defined by root-mean-square error, or RMS) and accuracy metrics were collected for forty-nine medically refractory epilepsy patients who underwent robotic-guided SEEG between April 2022 and February 2024. Thirty-two patients underwent stereotactic O-arm registration (using a newly-validated, Leksell G frame-based fiducial system), and seventeen patients underwent laser-based facial scanning. Entry-point (EE), target-point (TE) and angular error (AE) metrics were measured for every implanted electrode trajectory, across a total number of 920 electrodes. Wilcoxon Rank Sum Tests were utilized to compare error measures between the O-arm and laser groups.


Results: Out of 49 patients, 17 patients were female (7 laser, 10 O-arm) and 32 were male (10 laser, 22 O-arm). There was no statistical difference between groups using a chi-square test (p=0.4871, Pearson). The average age of patients was 28.7±11.1 years old (laser: 26.1±10.5; O-arm: 30.0±11.3; p=0.3134). Mean number of electrodes per patient was 19±3 (laser: 20±3; O-arm: 19±3; p=0.0752), with an average RMS-based registration error of 0.71±0.14 mm (laser: 0.62±0.11; O-arm: 0.77±0.14; p=0.0006). 24 patients (49%) had bilateral SEEG (10 laser, 14 O-arm), while 25 patients (51%) underwent unilateral implantation (7 laser, 18 O-arm). Electrode implantations were categorized by regional target site (laser: 117 frontal, 10 occipital, 51 parietal, 159 temporal locations; O-arm: 292 frontal, 10 occipital, 96 parietal, 185 temporal locations). The mean EE was 1.50±0.92 mm (laser: 1.86±0.92; O-arm: 1.29±0.85). The mean TE was 2.75±1.51 mm (laser: 2.90±1.59; O-arm: 2.67±1.45). The mean AE was 0.051±0.039 radians (laser: 0.062±0.048; O-arm: 0.045±0.032). Three Wilcoxon Rank Sum Tests with Chi-Square Approximations were performed, one for each error measure, to compare O-arm and laser lead accuracy (EE: p< 0.0001; TE: p=0.0329; AE: p< 0.0001).
Surgery