Robot-assisted stereoelectroencephalography in children

• Published in: Journal of neurosurgery. Pediatrics Vol. 23; no. 3; pp. 288 - 296
• Main Authors: McGovern, Robert A, Knight, Elia Pestana, Gupta, Ajay, Moosa, Ahsan N V, Wyllie, Elaine, Bingaman, William E, Gonzalez-Martinez, Jorge
• Format: Journal Article
• Language: English
• Published: United States 01-03-2019
• Subjects: Adolescent; Age Factors; Analysis of Variance; Child; Disease-Free Survival; Drug Resistant Epilepsy - physiopathology; Drug Resistant Epilepsy - surgery; Electrodes, Implanted - statistics & numerical data; Electroencephalography - adverse effects; Electroencephalography - methods; Female; Humans; Kaplan-Meier Estimate; Length of Stay; Male; Postoperative Hemorrhage - complications; Recurrence; Retrospective Studies; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - statistics & numerical data; Robotics; Stereotaxic Techniques - adverse effects; Treatment Outcome; EZ = epileptogenic zone; brain mapping; robotic surgical procedures; electrodes; LOS = length of hospital stay; pediatric epilepsy; PMC = patient management conference; stereoelectroencephalography; AED = antiepileptic drug; SEEG = stereoelectroencephalography; MEG = magnetoencephalography
• ISSN: 1933-0707; 1933-0715; 1933-0715
• DOI: 10.3171/2018.7.peds18305

OBJECTIVEThe goal in the study was to describe the clinical outcomes associated with robot-assisted stereoelectroencephalography (SEEG) in children.METHODSThe authors performed a retrospective, single-center study in consecutive children with medically refractory epilepsy who were undergoing robot-assisted SEEG. Kaplan-Meier survival analysis was used to calculate the probability of seizure freedom. Both univariate and multivariate methods were used to analyze the preoperative and operative factors associated with seizure freedom.RESULTSFifty-seven children underwent a total of 64 robot-assisted procedures. The patients' mean age was 12 years, an average of 6.4 antiepileptic drugs (AEDs) per patient had failed prior to implantation, and in 56% of the patients the disease was considered nonlesional. On average, children had 12.4 electrodes placed per implantation, with an implantation time of 9.6 minutes per electrode and a 10-day postoperative stay. SEEG analysis yielded a definable epileptogenic zone in 51 (89%) patients; 42 (74%) patients underwent surgery, half of whom were seizure free at last follow-up, 19.6 months from resection. In a multivariate generalized linear model, resective surgery, older age, and shorter SEEG-related hospital length of stay were associated with seizure freedom. In a Cox proportional hazards model including only the children who underwent resective surgery, older age was the only significant factor associated with seizure freedom. Complications related to bleeding were the major contributors to morbidity. One patient (1.5%) had a symptomatic hemorrhage resulting in a permanent neurological deficit.CONCLUSIONSThe authors report one of the largest pediatric-specific SEEG series demonstrating that the modern surgical management of medically refractory epilepsy in children can lead to seizure freedom in many patients, while also highlighting the challenges posed by this difficult patient population.