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 VIDEO SECTION-OPERATIVE NUANCES: STEP BY STEP
Year : 2021  |  Volume : 69  |  Issue : 3  |  Page : 587--591

Robotic-Guided Stereoelectroencephalography for Refractory Epilepsy: Technique and Nuances


1 Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
2 Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
3 Department of Neurosurgery, Airlangga University/Dr Soetomo General Hospital, Surabaya, Indonesia

Correspondence Address:
Prof. Poodipedi S Chandra
Professor of Neurosurgery, PI and Team Leader COE and MEG Centre, Core Faculty Epilepsy and Functional Neurosurgery Division, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.319246

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Background: Stereoelectroencephalography (SEEG) has become an integral part of epilepsy surgery, often used in the localization of the epileptogenic zone. It is an essential modality not only in the evaluation of nonlesional but also lesional drug refractory epilepsy, especially in the presence of anatomo-electro-clinical discordance. Objective: To describe our technique and the operative nuances involved in the performance of robotic SEEG placement. Methods: A 28-year lady with seizure onset at the age of 15 years presented with two types of seizures: one was associated with an aura of chest discomfort, palpitations along with oral and bilateral automatisms. There was associated speech and behavioral arrest along with ictal urinary incontinence. The other type has head turning to the right with secondary generalization lasting up to 1 min. Results: Multimodality investigations showed bilateral temporal origin of seizures. SEEG evaluation revealed left amygdala and anterior temporal neocortical (ATL) origin of seizures. The patient underwent left ATL and amygdalectomy. Histopathology revealed focal cortical dysplasia (FCD type Ib). The patient became seizure free (ILAE Class 1) at 1-year follow up. Conclusion: Robotic-guided SEEG is a safe and accurate method of evaluating complex MRI negative epilepsy.






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