Validation and Safety Profile of a Novel, Non-invasive Fiducial Attachment for Stereotactic Robotic-Guided Stereoelectroencephalography
Abstract number :
3.432
Submission category :
9. Surgery / 9C. All Ages
Year :
2023
Submission ID :
1417
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Akshay Sharma, MD – Cleveland Clinic Foundation
Nehaw Sarmey, MD – Cleveland Clinic Foundation; Stephen Harasimchuk, BA – SEEG Team Lead, Epilepsy Center, Cleveland Clinic Foundation; Sebastian Bakalarczyk, PhD – Cleveland Clinic Foundation; Francesco Pucci, MD – Neurological Surgery – University of Illinois, Chicago; Juan Bulacio, MD – Epilepsy Center – Cleveland Clinic Foundation; Richard Rammo, MD – Cleveland Clinic Foundation; William Bingaman, MD – Epilepsy Center – Cleveland Clinic Foundation; Demitre Serletis, MD, PhD – Epilepsy Center – Cleveland Clinic Foundation
Rationale: We conceptualized, developed, constructed and tested a novel, non-invasive, Leksell G frame-based fiducial attachment, to obviate the need for additional scalp incisions for skull fiducial placement during robotic-guided stereoelectroencephalography (sEEG). The goal was to streamline an increased number of fixed reference points available for O-arm (Medtronic) based stereotactic registration, without additional scalp incisions or further hair shaving.
Methods: We reviewed our prospectively collected registration data using the non-invasive fiducial device across 29 adult and pediatric epilepsy patients consecutively undergoing sEEG for invasive monitoring, treated between May 2022 and July 2023. Rosa One Brain (Zimmer Biomet) was used for trajectory planning and electrode implantation. Post-operative clinical and radiographic data were computed and quantified, including mean registration error for all patients. Trajectory errors were measured for individual electrodes in three illustrative cases (representing bilateral, right, and left-sided implantations), including Euclidean and angular errors. Descriptive statistics for lead error were calculated, accordingly.
Results: Twenty-nine patients (19 male and 10 female) underwent sEEG implantation during the specified time-period. In summary, 13 patients underwent bilateral hemispheric implantation; 12 patients had left unilateral implantation; and four patients had right unilateral implantation. The mean number of electrodes per patient was 18 ± 3. Using the non-invasive fiducial device, the average mean registration error was computed to be 0.75 ± 0.11 mm. All patients were implanted with Ad-Tech depth electrodes (Ad-Tech Medical). No clinically-relevant complications were reported, although one patient developed a trace (<
Surgery