Robotic-Assisted Stereotaxy for Deep Brain Stimulation Lead Implantation in Awake Patients
Robotic-Assisted Stereotaxy for Deep Brain Stimulation Lead Implantation in Awake Patients
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DOI：
10.1093/ons/opaa029
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发表时间：
2020-10-01
影响因子：
2.3
通讯作者：
Richardson, R. Mark
中科院分区：
文献类型：
--
作者：
Faraji, Amir H.;Kokkinos, Vasileios;Richardson, R. Mark
背景技术背景：机器人辅助的立体定向已经越来越多地被用于基于其效率、准确性和精确度的立体脑电描记术中的电极导线植入。尽管最初被开发用于脑深部电刺激（DBS）手术，但对该适应症的采用并不广泛。目的：描述最近机器人辅助立体定向术的经验和工作流程，用于清醒患者的DBS电极导线植入，有和没有微电极记录（MER），包括使用皮质电图（ECoG）进行术中研究的考虑因素。方法：对使用机器人辅助立体定向术同时植入双侧DBS电极导线的20例连续患者进行了回顾性分析。通过比较术前目标与术后计算机断层扫描中靶平面中的DBS电极导线位置来确定径向误差。有关任何术后并发症的信息通过图表review.Results：机器人配准的一种新方法。我们描述了一个标准的工作流程，允许MER和/或ECoG研究，并简化了工作流程的情况下，MER是不需要的。所有20例患者的电极导线置入的总体径向误差为1.14 +/- 0.11 mm。前10例患者的径向误差（1.46 +/- 0.19 mm）与后10例患者的径向误差（0.86 +/-0.09 mm）之间存在显著差异（P = 0.006）。结论：机器人辅助立体定向有可能提高精度，减少人为错误，相比传统的基于框架的DBS手术，没有负面影响患者的安全性或进行清醒神经生理学研究的能力。
BACKGROUND: Robotic-assisted stereotaxy has been increasingly adopted for lead implantation in stereoelectroencephalography based on its efficiency, accuracy, and precision. Despite initially being developed for use in deep brain stimulation (DBS) surgery, adoption for this indication has not been widespread.OBJECTIVE: To describe a recent robotic-assisted stereotaxy experience and workflow for DBS lead implantation in awake patients with and without microelectrode recording (MER), including considerations for intraoperative research using electrocorticography (ECoG).METHODS: A retrospective review of 20 consecutive patients who underwent simultaneous bilateral DBS lead implantation using robotic-assisted stereotaxy was performed. Radial error was determined by comparing the preoperative target with the DBS lead position in the targeting plane on postoperative computed tomography. Information regarding any postoperative complications was obtained by chart review.RESULTS: A novel method for robot coregistration was developed. We describe a standard workflow that allows for MER and/or ECoG research, and a streamlined workflow for cases in which MER is not required. The overall radial error for lead placement across all 20 patients was 1.14 +/- 0.11 mm. A significant difference (P = .006) existed between the radial error of the first 10 patients (1.46 +/- 0.19 mm) as compared with the second 10 patients (0.86 +/- 0.09 mm). No complications were encountered.CONCLUSION: Robotic-assisted stereotaxy has the potential to increase precision and reduce human error, compared to traditional frame-based DBS surgery, without negatively impacting patient safety or the ability to perform awake neurophysiology research.