Robot-assisted vs. manually guided stereoelectroencephalography for refractory epilepsy: a systematic review and meta-analysis

被引：9

作者：

Gomes, Fernando Cotrim ^{[1
]}

Larcipretti, Anna Laura Lima ^{[2
]}

Nager, Gabriela ^{[3
]}

Dagostin, Caroline Serafim ^{[4
]}

Udoma-Udofa, Ofonime Chantal ^{[5
]}

Pontes, Julia Pereira Muniz ^{[6
]}

de Oliveira, Jessica Sales ^{[7
]}

de Souza, Justine Hellen Cavalcanti ^{[7
]}

Bannach, Matheus de Andrade ^{[8
]}

机构：

[1] Univ Fed Minas Gerais, Dept Med, Belo Horizonte, Brazil

[2] Univ Fed Ouro Preto, Dept Med, Ouro Preto, Brazil

[3] Fed Univ State Rio de Janeiro, Dept Med, Rio De Janeiro, Brazil

[4] Univ Extreme South Santa Catarina, Dept Med, Criciuma, Brazil

[5] Univ Fed Juiz de Fora, Dept Med, Campus Juiz de Fora, Juiz De Fora, MG, Brazil

[6] Univ Estado Rio De Janeiro, Rio De Janeiro, Brazil

[7] Natl Univ Rosario, Rosario, Argentina

[8] Univ Fed Goias, Dept Surg, Neurol & Neurosurg Unit, BR-74690900 Goiania, Brazil

来源：

NEUROSURGICAL REVIEW | 2023年 / 46卷 / 01期

关键词：

Stereoelectroencephalography; Robotic; Refractory epilepsy; SURGICAL SITE INFECTIONS; RISK-FACTORS; ACCURACY;

D O I：

10.1007/s10143-023-01992-8

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Robotic assistance has improved electrode implantation precision in stereoelectroencephalography (SEEG) for refractory epilepsy patients. We sought to assess the relative safety of the robotic-assisted (RA) procedure compared to the traditional hand-guided one. A systematic search on PubMed, Web of Science, Embase, and Cochrane was performed for studies directly comparing robot-assisted vs. manually guided SEEG to treat refractory epilepsy. The primary outcomes included target point error (TPE), entry point error (EPE), time of implantation of each electrode, operative time, postoperative intracranial hemorrhage, infection, and neurologic deficit. We included 427 patients from 11 studies, of whom 232 (54.3%) underwent robot-assisted surgery and 196 (45.7%) underwent manually guided surgery. The primary endpoint, TPE, was not statistically significant (MD 0.04 mm; 95% CI - 0.21, - 0.29; p = 0.76). Nonetheless, EPE was significantly lower in the intervention group (MD - 0.57 mm; 95% CI - 1.08; - 0.06; p = 0.03). Total operative time was significantly lower in the RA group (MD - 23.66 min; 95% CI - 32.01, - 15.31; p < 0.00001), as well as the individual time of implantation of each electrode (MD - 3.35 min; 95% CI - 3.68, - 3.03; p < 0.00001). Postoperative intracranial hemorrhage did not differ between groups: robotic (9/145; 6.2%) vs. manual (8/139; 5.7%) (RR 0.97; 95% CI 0.40-2.34; p = 0.94). There was no statistically relevant difference in infection (p = 0.4) and postoperative neurological deficit (p = 0.47) incidence between the two groups. In this analysis, there is a potential relevance in the RA procedure when comparing the traditional one, since operative time, time of implantation of each electrode, and EPE were significantly lower in the robotic group. More research is needed to corroborate the superiority of this novel technique.

引用

页数：8