The clinical application of neuro-robot in the resection of epileptic foci: a novel method assisting epilepsy surgery.

Journal: Journal of robotic surgery
PMID: 37308790

Abstract

During surgery for foci-related epilepsy, neurosurgeons face significant difficulties in identifying and resecting MRI-negative or deep-seated epileptic foci. Here, we present a neuro-robotic navigation system that is specifically designed for resection of MRI negative epileptic foci. We recruited 52 epileptic patients, and randomly assigned them to treatment group with either neuro-robotic navigation or conventional neuronavigation system. For each patient, in the neuro-robotic navigation group, we integrated multimodality imaging including MRI and PET-CT into the robotic workstation and marked the boundary of foci from the fused image. During surgery, this boundary was delineated by the robotic laser device with high accuracy, guiding resection for the surgeon. For deeply seated foci, we exploited the neuro-robotic navigation system to localize the deepest point with biopsy needle insertion and methylene dye application to locate the boundary of the foci. Our results show that, compared with the conventional neuronavigation, the neuro-robotic navigation system performs equally well in MRI positive epilepsy patients (ENGEL I ratio: 71.4% vs 100%, p = 0.255) systems and show better performance in patients with MRI-negative focal cortical dysplasia (ENGEL I ratio: 88.2% vs 50%, p = 0.0439). At present, there are no documented neurosurgery robots with similar function and application in the field of epilepsy. Our research highlights the added value of using neuro-robotic navigation systems in resection surgery for epilepsy, particularly in cases that involve MRI-negative or deep-seated epileptic foci.

Authors

  • Yichen Xu
    Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
  • Yingchuan Chen
    Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
  • Huanguang Liu
    Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
  • Hua Zhang
    School of Clinical Medicine, Hangzhou Medical College, Hangzhou, China.
  • Zixiao Yin
    Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
  • Defeng Liu
    Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
  • Guanyu Zhu
    Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
  • Yu Diao
    Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
  • Delong Wu
    Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
  • Hutao Xie
    Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
  • Wenhan Hu
    Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
  • Xin Zhang
    First Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, Shenyang, China.
  • Xiaoqiu Shao
    Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, China.
  • Kai Zhang
    Anhui Province Key Laboratory of Respiratory Tumor and Infectious Disease, First Affiliated Hospital of Bengbu Medical University, Bengbu, China.
  • Jianguo Zhang
    College of Automation, Harbin Engineering University, No. 145, Nantong street, Harbin, China.
  • Anchao Yang
    Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China. yang.anchao@163.com.

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