A comparison between robot-guided and stereotactic frame-based stereoelectroencephalography (SEEG) electrode implantation for drug-resistant epilepsy

The original stereoelectroencephalography frame-based implantation technique has been proven to be safe and effective. But this procedure is complicated and time-consuming. With the development of modern robotic technology, robot-guided intracerebral electrodes implantation is being implemented at many epilepsy centers. We retrospectively analyzed the results of 147 patients who underwent SEEG electrode implantation surgery at our hospital. Robot-guided surgery was performed on 87 patients from January 2018 to December 2019. The remaining 60 patients received frame-based surgery from June 2015 to June 2016. 147 patients underwent a total of 149 SEEG electrode implantation procedures. The mean error of the entry point of the robot-guided surgery group was lower than that of the frame-based surgery group (1.48 ± 1.46 mm vs. 1.59 ± 0.9 mm, P < 0.001). Also, the robot group had a higher mean number of electrodes per patient (8.9 ± 2.2 vs. 7.9 ± 2.5, P = 0.004), a significantly shorter mean operative time (69.5 ± 23.3 min vs. 106.8 ± 39.8 min, P < 0.001), and mean time per electrode (7.9 ± 1.3 min vs. 13.5 ± 3.1 min, P < 0.001) than the frame-based group. In the robot-guided group, the target point (TP) error was positively correlated with skull thickness (P = 0.001) and negatively correlated with the electrode-skull angle (P = 0.041). The mean target point error and hemorrhage rates were also analyzed, but no differences were observed between the two groups. Robot-guided surgery has a higher entry point accuracy and efficiency. Electrode implantation accuracy was affected by the skull thickness and electrode-skull angle.