Use of the Globus ExcelsiusGPS System for Robotic Stereoelectroencephalography: An Initial Experience

Abstract

Stereoelectroencephalography (SEEG) is a critical tool used in the identification of epileptogenic zones. While stereotactic frame-based SEEG procedures have been performed traditionally, newer robotic assisted SEEG procedures have become increasingly common. To evaluate the accuracy, efficacy, and safety of the ExcelsiusGPS® robot in SEEG procedures. Five consecutive adult patients with drug resistant epilepsy were identified as SEEG candidates via a multi-disciplinary epilepsy surgery committee. Preoperative scans were merged onto the robot to plan electrode placement. With the use of a camera system, dynamic reference base, and surveillance markers, the robotic arm was used to establish the trajectory of the electrodes. Post-operative CT scans were merged onto the preoperatively planned trajectory and the radial, depth, and entry errors we calculated. Fiducial registration error was calculated for four cases to determine error between the patient and intraoperative CT merge. A total of 59 electrodes were placed. The mean age at surgery was 41.6 ± 15.1 years. Mean operating room time, anesthesia time, and surgical time was 301.6 ± 44.4 min, 261.6 ± 50.2 min, and 155.8 ± 48.8 min, respectively. The overall mean depth, radial, and entry errors were 2.5 ± 1.9 mm, 1.9 ± 1.5 mm, and 1.6 ± 1.2 mm. Mean fiducial registration error retrospectively calculated for four of five cases were 0.13 ± 0.04 mm.There were no perioperative complications. The initial performance of the ExcelsiusGPS® robotic system yielded comparable results to other systems currently in use for adult SEEG procedures.