The Application Of ROSA Navigated Intracranial Electrode Implantation Technique In The Epilepsy Surgery

Objective: To evaluate the safety and efficacy of intracranial electrodes,ROSA robot aided system implants intracranial electrodes to confirm epilepsy and cortical functional areas for guiding the surgical treatment of epilepsy.Methods: The data of 21 patients with drug-resistant epilepsy in General Hospital of Shenyang Military Region from August 2016 to December 2016 who underwent ROSA navigated implantation of intracranial electrode for localization of epileptogenic.The type of 21 Patients include focal seizures,generalized epileptic seizures.Clinical data includes: medical history,laboratory test,neuro-imaging examination,Electrophysiological examination,neuro-psychological examination,the detection rates of epileptogenic zone,complications and seizure outcomes after surgical resection were prospectively collected and analyzed.Operation method: design of electrode implantation plan,implanted electrodes,verify accuracy of intracranial electrode,record electroencephalogram,locate epileptogenic zone according to the seizure origin of intracranial electrode and resect epileptogenic zone.Operation principle : according to the epileptogenic zone,Preoperative SEEG monitoring results and electrical stimulation of the cortex results,we choose different modus operandi or combined modus operandi,During the operation,to further confirm the range of epileptogenic zone and operative region,cortical electrodes were used to detect the epileptogenic zone and surrounding areas.Cortical electrode monitor epileptogenic zone and abnormal discharge in all cases.In the premise of preserving the important domain of the patients,the epileptogenic zone was resected under microsurgery and monitored under cortical EEG.Results: 21 patients implanted 195 electrodes,with a mean of 9.2.The electrodes were preserved for 7—35days(mean13 days),and 2—5 clinical seizures were observed with a mean of 3;From the studied group of21 patients.The area of seizure onset could be localized in 20 patients,Surgical treatment was performed in 19 patients.8 patients underwent surgical resection following stereoelectroencephalography(SEEG)evaluation.patients underwent resection of temporal pole,hippocampus and amygdala,1 patient underwent resection frontal cortex dysplasia,1 patient underwent resection of the right temporal lobe cortical dysplasia and occipital amputation;1 patient underwent resection of left parietal malacia and epileptogenic zone;1 patient underwent resection of right superior frontal gyrus,middle frontal gyrus and frontal cortex;1 patient underwent resection of left medial occipital cortex;1patient underwent resection of left frontal and anterior temporal lobe;1 patient underwent resection of inferior parietal lobe and partial temporal lobe;1 patient underwent resection of inferior frontal gyrus and frontal operculum;1 patient underwent resection of right posterior cingulate gyrus and underwent callosotomy;1 patient underwent resection of right middle frontal gyrus and superior frontal gyrus;1 patients underwent resection of the cortex and right supramarginal gyrus subpial transection of Broca area.1 patient refused surgical treatment.1 patients failed to confirm the epileptogenic zone and adjusted the medication;complications: 1 patient suffered intracranial hemorrhage caused by the implantation and no neurologic symptoms,1 case experiences scalp infection and There was no cerebrospinal fluid leak,intracranial hematoma,electrodes fracture or patient death.19 patients follow-up,In the group of 19 patients,14 patients were Engel I class,2 patients were Engel II,3 patients were Engel and1? no patient was Engel IV.Conclusion: the ROSA navigated stereotactic electrode implantation which is an effective means of locating epileptic foci,used in preoperative evaluation of intractable epilepsy drug,is safe-guaranteed,less-complication and high in detection rate.