摘要目的 探讨机器人辅助立体脑电图电极植入在癫痫外科应用中的精准性、效率及安全性.方法 回顾性纳入2018年2月至6月首都医科大学宣武医院北京功能神经外科研究所收治并行机器人辅助立体脑电图电极植入的23例药物难治性癫痫患者(简称机器人组);对照组为2017年10月至2018年1月采用CRW立体定向仪引导下行电极植入的25例药物难治性癫痫患者(简称立体定向组).术后对两组患者行CT薄层连续平扫,并据此测量电极的实际植入靶点与设计靶点之间的误差.记算单根电极植入所需的时间,并记录术后发生并发症的情况.比较两组电极植入靶点的误差、手术时间及相关并发症的发生率.结果 在机器人组中,23例癫痫患者共植入179根电极,合计2 642个触点,每例患者植入电极的中位数量为8(5 ～10)根,含120(76 ～ 136)个触点.在立体定向组中,25例患者共植入172根电极,合计2 520个触点,每例患者植入电极的中位数量为7(6 ～9)根,含100(60 ～128)个触点.机器人组与立体定向组单根电极的中位植入误差分别为1.4(0.4～9.3)mm、1.4(0～4.6)mm,两组比较差异无统计学意义(P＞0.05).与立体定向组比较,机器人组的手术时间明显缩短[中位数(范围)分别为14.7 (10.3～18.5)min、8.0(5.9～12.8) min,P＜0.01].术后机器人组中,2例(8.7％)出现无症状性颅内出血,无感染或其他并发症发生;立体定向组中,1例(4.0％)颅内出血致对侧肢体肌力下降,1例(4.0％)出现无症状性颅内出血,无感染或其他并发症发生.结论 机器人辅助技术可以显著提高癫痫外科中立体脑电图电极植入的效率,并有良好的精准性和较高的安全性.

abstractsObjective To explore the precision,efficiency and safety of robot-assisted stereoencephalography (SEEG) electrode implantation applied in epilepsy surgery.Methods A retrospective analysis was conducted on 23 patients of refractory epilepsy who were admitted to Beijing Institute of Functional Neurosurgery,Xuanwu Hospital of Capital Medical University from February 2018 to June 2018 and underwent robot-assisted SEEG electrode implantation (‘robot’ group).A total of 25 refractory epilepsy patients admitted from October 2017 to January 2018 underwent CRW stereotactic apparatus-guided SEEG implantation and served as control (‘ CRW’ group).Continuous thin-slice CT was conducted post operation in each case,based on which the distance between the actual and planned target of each electrode trajectory was measured and set as operational deviation.Operational duration for each electrode implantation and incidences of postoperative complications were documented.The parameters as above were compared between the 2 groups.Results In the ‘robot’ group,a total of 179SEEG electrodes with 2 642 contacts were implanted in this series (23 cases),with the median of 8 (5-10) electrodes with 120 (76-136)contacts in each patient.In the ‘CRW’ group,25 patients underwent implantation of 172 electrodes with 2 520 contacts,with the median of 7 (6-9)electrodes with 100 (60-128) contacts in each patient.The operational deviation of each electrode was 1.4 (0.4-9.3) mm (‘robot’ group) and 1.4 (0-4.6) mm (‘CRW’ group),respectively,which had no statistical difference (P ＞0.05).Compared with ‘ CRW’ group,the ‘ robot’ group had significantly shorter operational duration [8 (5.9-12.8) min vs.14.7 (10.3-18.5) min,P ＜ 0.01] for each electrode implantation.In the ‘ robot’ group,there were 2 cases (8.7％) of asymptomatic intracranial hemorrhage.No cases of infection or other complications were observed.In the ‘ CRW’ group,there were 1 case (4.0％) of intracerebral hemorrhage causing contralateral paralysis,1 case (4.0％) of asymptomatic hemorrhage and no cases of other complications.Conclusions Robotassisted technique seems to be able to remarkedly increase the efficiency of SEEG electrode implantation with relatively good precision and safety,which could thus be recommended for clinical use and promotion.