Accuracy And Safety Of ROSA Robot Assisted Stereotactic Electroencephalogram Implantation Under Local Anesthesia

Objiective: To investigate the accuracy and safety of ROSA robotic system assisted stereotactic electroencephalogram electrode implantation under local anesthesia,by comparing the inset error and target error of stereotactic electroencephalogram electrode implantation under local anesthesia and general anesthesia,and the incidence of complications.Methods: A retrospective analysis of 47 patients with drug-refractory epilepsy who underwent SEEG surgery under the ROSA robotic system in the General Hospital of Northern Theater Command from November 2016 to November 2018.According to the different anesthesia methods used in the operation,the patients were divided into local anesthesia group.and the general anesthesia group.The local anesthesia group was 37 patients undergoing SEEG under local anesthesia,including 29 males and 8 females,aged 16 to 63 years,with an average age of 30.40 years.The general anesthesia group was 10 patients undergoing SEEG surgery under general anesthesia.There are 6 males and 4 females,aged 3 to 47 years old,with an average age of 30.78 years.All patients underwent a 3.0T 3D-MRI scan and enhancement of the head before surgery.The head CTA was performed one day before surgery,and image fusion was performed at the ROSA robot system workstation.Pre-operative planning of electrode trajectories,including electrode entry points and targets,based on patient episodes of symptoms and preoperative scalp electroencephalography,MRI,CTA,PET-CT,neuropsychological examination,and multimodal image fusion of preoperative imaging.The point and the path of the electrode in the brain tissue,and then circumvent the path vessel according to CTA imaging,adjust the planning trajectory,make the planned path as far as possible from the blood vessel,and avoid intracranial hemorrhage.All patients were connected to the ROSA robotic system using the Leksell headgear.The registration method used contactless registration with a registration error of 0.75 mm.The head 3D reconstruction CT was performed within 6 hours after operation,and the postoperative CT data was imported into the ROSA robot system workstation through the PACS system to accurately measure and record the lateral error between each electrode actually implanted and the electrode planning trajectory.The patients were observed for complications such as intracranial hemorrhage,electrode fracture and intracranial infection.Results: A total of 53 operations were performed.A total of 477 electrodes were planned,and 477 electrodes were actually implanted.The actual electrode implantation success rate was 100%.On average,9 electrodes were implanted each time,and the single implant electrode ranged from 3 to 16.There were 37 patients in the local anesthesia group,41 operations were performed,384 electrodes were implanted,384 electrodes were actually implanted,accounting for 80.5% of the total implant electrodes;10 patients in the general anesthesia group underwent 12 operations.93 implanted electrodes were planned,and 93 electrodes were actually implanted,accounting for 19.5% of the total implanted electrodes;131 in the frontal lobe,128 in the temporal lobe,65 in the parietal lobe,76 in the occipital lobe,and 70 in the insula.7 in hypothalamus.The inset error of the local anesthesia group was 1.28±0.82mm(the error range was 0.03mm~3.77mm),the target error was 1.78±1.12mm(the error range was 0.03mm~4.97mm);the inset error of the patients in the general anesthesia group was 1.27±0.66mm(error range is 0.07mm~3.28mm),target error is 1.59±0.87mm(error range is 0.04mm~3.82mm).Statistical analysis was performed on the inset and target errors of the local anesthesia group and the general anesthesia group.The two groups were p=0.92 in inset errors,and the two groups were p=0.12 in target errors,both of which were greater than 0.05.There was no statistically significant difference in the error,indicating that the SEEG electrode implantation under local anesthesia had no significant difference with the accuracy of SEEG electrode implantation under general anesthesia.In the local anesthesia group,a small amount of intracranial hemorrhage occurred when the electrode was removed,no neurological damage,and the hematoma was absorbed by himself.There was no bleeding in the general anesthesia group.There was no infection in either group,and no electrode was broken.The incidence of overall complications in the local anesthesia group was 2.7%.Concluusions: There was no statistics significant difference in the entry error and target error between the local anesthesia and the ROSA robotic system assisted SEEG electrode implantation under general anesthesia.The incidence of complications was not higher than that of SEEG electrode implantation under general anesthesia.It shows that the ROSA robotic system assisted SEEG electrode implantation under local anesthesia is accurate and safe.