The authors have no acknowledgements.

All devices used herein are FDA approved and the protocol contained herein constitutes the standard of care at our institution. As such, no IRB approval was needed for the detailing of this protocol.
1. Pre-implantation phase
<ol>
	<li>Create an anatamo-electro-clinical (AEC) hypothesis. 
	NOTE: Creation of the AEC hypothesis relies on the coordination of multiple non-invasive techniques for identifying the potential EZ. A team of experts, including epileptologists, radiologists, and epilepsy surgeons will typically convene a meeting to discuss the clinical data for each patient in order to create the AEC hypothesis, which serves as the initial hypothesis for the patient&#8217;s EZ. The details of how this is accomplished is beyond the scope of this article.</li>
	<li>Identify the best methodology for invasive monitoring depending on the location of the AEC hypothesis. Table 1 lists the different scenarios for which SEEG is preferred over subdural grids (SDG) with or without depth electrodes for invasive monitoring.</li>
	<li>After a patient is deemed a candidate for SEEG evaluation, create an implantation strategy. 
	NOTE: The implantation strategy should adequately cover the area identified as a part of the AEC hypothesis as well as the wider epileptogenic network in general and neighboring areas of eloquent cortex. This monitoring aids the surgeon in defining the borders of the resection.
	<ol>
		<li>Obtain a pre-operative volumetric MRI and CTA.</li>
		<li>Transfer the images in DICOM format to the stereotactic robot&#8217;s native planning software and perform imaging fusion (T1+Gadolinium MRI fused with CTA). 
		NOTE: Imaging fusion is performed automatically by the robot&#8217;s software. One need only select the studies that need to be fused.</li>
		<li>Plan the trajectory of each individual electrode array within the 3D reconstruction of the MRI-CTA fusion, making sure to maximize sampling from a multitude of areas, including superficial, intermediate, and deep cortical and subcortical areas within the AEC hypothesis.
		<ol>
			<li>Define each trajectory by manually selecting the surface entry point and deep target point for each electrode. 
			NOTE: Generally, it is best to initially use a working distance of 150 mm from the drilling platform to the deep target point and then adjust the depth to maximally reduce the working distance in order to improve implantation accuracy.</li>
		</ol>
		</li>
		<li>Verify each implantation trajectory.
		<ol>
			<li>Review each electrode in the 3D MRI-CTA fusion reconstruction individually to make sure that the trajectory does not compromise any vascular structures, adjusting any trajectories as needed.</li>
		</ol>
		</li>
		<li>Review the overall implantation schema in the 3D MRI reconstruction, assessing for any trajectory collisions.</li>
		<li>Verify that the surface entry points are all at least 1.5 cm apart on the skin surface, as anything closer than this would be prohibitive to implantation later.</li>
	</ol>
	</li>
</ol>
2. Operative technique
<ol>
	<li>In the OR, prepare the patient and place them supine while preparing the stereotactic robot for surgery.
	<ol>
		<li>Intubate under general anesthesia according to the recommendations of the anesthesiologist. Use propofol for sufficient anesthesia and verify by adequate electrophysiological recordings as certified by a clinical epileptologist.</li>
		<li>Fix the patient&#8217;s head using a three-point fixation head holder. 
		NOTE: This is a standard 4-point Lexell frame. Occasionally one of the front posts will be removed in order to facilitate registration of the robot to the patient, as described later. Therefore, the fixation is referred to as 3-point.</li>
		<li>Position the robot at the head of the patient, such that the distance between the base of the robotic arm and the midpoint of the cranium is 70 cm. Lock the robot into position and secure the three-point head-holder to the robot. 
		NOTE: Do not make any more adjustments to the position of the patient or the robot after this time. Any further adjustment after this point will potentially result in implantation inaccuracies.</li>
		<li>Use the semi-automatic laser based facial recognition system to register the preoperative volumetric MRI with the patient, following all prompts given by the robot.
		<ol>
			<li>Calibrate the laser using the set distance calibration tool.</li>
			<li>Select the preset anatomical facial landmarks manually with the laser. Registration is then completed as the robot automatically scans the facial surface.</li>
			<li>Confirm the accuracy of the registration by correlating additional independent surface landmarks with the registered MRI. 
			NOTE: The planned trajectories are then automatically verified by the robot software.</li>
		</ol>
		</li>
		<li>Prepare and drape the patient in standard sterile fashion.</li>
		<li>Drape the robotic working arm using sterile plastic.</li>
		<li>Attach the drilling platform, with a 2.5 mm working cannula, to the robotic arm.</li>
	</ol>
	</li>
	<li>Implant the bolts along their designated trajectories.
	<ol>
		<li>Select the desired trajectory on the touch screen of the robot.</li>
		<li>Step on the robot pedal to initiate movement of the robotic arm to the correct trajectory. When the correct position is reached, the arm is automatically locked by the robot.</li>
		<li>Insert a 2 mm drill through the working cannula and use it to create a pinhole through the entire thickness of the skull.</li>
		<li>Open the dura with an insulated dural perforator using monopolar cautery at a low setting. 
		NOTE: Opening the dura can be particularly challenging in small children. Because the dura is not completely adherent to the internal layers of the skull, it is very easy to displace rather than open the dura without noticing.</li>
		<li>Screw guide bolt firmly into each pin hole.</li>
		<li>Measure the distance from the drilling platform to the guide bolt using a sterile ruler. 
		NOTE: This is a fixed distance related to the length of the drilling adapter.
		<ol>
			<li>Subtract this measured distance from the value of the distance &#8220;platform to target&#8221; used in planning the trajectory. 
			NOTE: Remember that the recommendation is to always use the standard 150 mm platform to target distance unless a need arises to change this distance. Using this standard will simplify this step in the OR.</li>
			<li>Record and note the result as it will be used later as the final length of the implanted electrode.</li>
		</ol>
		</li>
		<li>Measure and note the final length of the electrode and ensure that it matches the newly calculated length for the bolt. Ensure the electrode and bolt have matching labels to prevent confusion later during electrode implantation.</li>
		<li>Repeat steps 2.2.1 &#8211; 2.2.7 for every bolt (i.e., implant all bolts) and mark all electrodes accordingly.</li>
	</ol>
	</li>
	<li>Change surgical gloves and open a new sterile field.</li>
	<li>Implant all electrodes to the target depth via the implanted bolts.
	<ol>
		<li>Insert a 2 mm diameter stylet through the guide bolt to the intended depth of the final electrode as calculated after implantation of the bolt previously.</li>
		<li>Immediately insert the electrode through the bolt after removing the stylet and screw the electrode into the bolt for fixation.</li>
		<li>Ensure that the electrode is appropriately labeled.</li>
		<li>Repeat steps 2.4.1 &#8211; 2.4.3 for every electrode.</li>
	</ol>
	</li>
	<li>Connect the electrodes to the clinical electrophysiology hardware.</li>
	<li>Wrap the patient&#8217;s head using standard head bandaging technique.</li>
</ol>

<ol>
	<li>World Health Organization. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Epilepsy. , (2018).</li><li>Talairach, J., Bancaud, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereotaxic+approach+to+epilepsy.">Stereotaxic approach to epilepsy.</a> Progress in neurological surgery. 5, 297-354 (1973).</li><li>Bancaud, J., Talairach, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+organization+of+the+supplementary+motor+area.+Data+obtained+by+stereo-E.E.G.">Functional organization of the supplementary motor area. Data obtained by stereo-E.E.G.</a> Neurochirurgie. 13, 343-356 (1967).</li><li>Jehi, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Epileptogenic+Zone:+Concept+and+Definition.">The Epileptogenic Zone: Concept and Definition.</a> Epilepsy Currents. 18 (1), 12-16 (2018).</li><li>Nowell, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel+method+for+implementation+of+frameless+StereoEEG+in+epilepsy+surgery.">A novel method for implementation of frameless StereoEEG in epilepsy surgery.</a> Operative Neurosurgery. 10 (4), 525-534 (2014).</li><li>Abel, T. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frameless+robot-assisted+stereoelectroencephalography+in+children:+technical+aspects+and+comparison+with+Talairach+frame+technique.">Frameless robot-assisted stereoelectroencephalography in children: technical aspects and comparison with Talairach frame technique.</a> Journal of Neurosurgery: Pediatrics. 1, 1-10 (2018).</li><li>van der Loo, L. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Methodology,+outcome,+safety+and+in+vivo+accuracy+in+traditional+frame-based+stereoelectroencephalography.">Methodology, outcome, safety and in vivo accuracy in traditional frame-based stereoelectroencephalography.</a> Acta neurochirurgica. 159 (9), 1733-1746 (2017).</li><li>Gonz&#225;lez-Mart&#237;nez, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Technique,+results,+and+complications+related+to+robot-assisted+stereoelectroencephalography.">Technique, results, and complications related to robot-assisted stereoelectroencephalography.</a> Neurosurgery. 78 (2), 169-180 (2015).</li><li>Mullin, J. P., Smithason, S., Gonzalez-Martinez, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereo-electro-encephalo-graphy+(SEEG)+with+robotic+assistance+in+the+presurgical+evaluation+of+medical+refractory+epilepsy:+a+technical+note.">Stereo-electro-encephalo-graphy (SEEG) with robotic assistance in the presurgical evaluation of medical refractory epilepsy: a technical note.</a> Journal of visualized experiments. , 112 (2016).</li><li>Jones, J. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Techniques+for+placement+of+stereotactic+electroencephalographic+depth+electrodes:+Comparison+of+implantation+and+tracking+accuracies+in+a+cadaveric+human+study.">Techniques for placement of stereotactic electroencephalographic depth electrodes: Comparison of implantation and tracking accuracies in a cadaveric human study.</a> Epilepsia. 59 (9), 1667-1675 (2018).</li><li>Mullin, J. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+SEEG+safe?+A+systematic+review+and+meta-analysis+of+stereo-electroencephalography-related+complications.">Is SEEG safe? A systematic review and meta-analysis of stereo-electroencephalography-related complications.</a> Epilepsia. 57 (3), 386-401 (2016).</li><li>Serletis, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+stereotactic+approach+for+mapping+epileptic+networks:+a+prospective+study+of+200+patients.">The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients.</a> Journal of Neurosurgery. 121, 1239-1246 (2014).</li><li>Taussig, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereo-electroencephalography+(SEEG)+in+65+children:+an+effective+and+safe+diagnostic+method+for+pre-surgical+diagnosis,+independent+of+age.">Stereo-electroencephalography (SEEG) in 65 children: an effective and safe diagnostic method for pre-surgical diagnosis, independent of age.</a> Epileptic Disorders. 16, 280-295 (2014).</li><li>Munyon, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+3-dimensional+grid:+a+novel+approach+to+stereoelectroencephalography.">The 3-dimensional grid: a novel approach to stereoelectroencephalography.</a> Neurosurgery. 11, 127-133 (2015).</li><li>Ortler, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frame-based+vs+frameless+placement+of+intrahippocampal+depth+electrodes+in+patients+with+refractory+epilepsy:+a+comparative+in+vivo+(application)+study.">Frame-based vs frameless placement of intrahippocampal depth electrodes in patients with refractory epilepsy: a comparative in vivo (application) study.</a> Neurosurgery. 68, 881-887 (2011).</li></ol>

The authors have nothing to disclose.

Meticulously defining of the AEC hypothesis coupled with particularly detailed attention to the design of the implantation strategy is ultimately what will determine the success of the SEEG methodology for each individual patient. As such, careful pre-surgical planning of the procedure is critical and makes for a relatively simple, low-risk surgery. Generally it is best to orient the trajectories orthogonally to the sagittal midline, thereby facilitating an easier anatomo-electrophysiological correlation in the future an...

Medically refractory epilepsy (MRE) is estimated to afflict fifteen million people world-wide1. Many of these patients, therefore, may well be treated with surgery. Epilepsy surgery relies on the precise localization of the theorized epileptogenic zone (EZ) in order to guide surgical resections. Jean Tailarach and Jean Bancaud developed the stereoelectroencephalography (SEEG) methodology in the 1950s as a method for more accurately localizing the EZ based on the in situ electrophysiology of the epileptic brain in both cortical and deep structures2,3. However, only recently has the SEEG methodology started to gain favor across North America4.
Various techniques and technologies are used throughout the world as part of the SEEG methodology, based on the clinical experience of different professionals and epilepsy centers5,6,7. Recently, however, there has been an evolution of the surgical techniques used to implant SEEG electrodes, beyond the classical use manual headframe based strategies. Specifically, the use of robotic stereotactic guidance systems has been shown to be an accurate alternative for SEEG implantation8. Robotic implantation can be safely and effectively used by those with surgical expertise who are looking for a faster, more automated, approach to electrode implantation.
Herein is discussed the specific steps undertaken when employing the use of a robotic stereotactic guidance system for the implantation of SEEG electrodes. Though the SEEG methodology has previously been described, herein particular attention is given to the surgical technique employed with the use of the robot9.

<table><tbody><tr><td>2 mm drill bit</td><td>DIXI</td><td>KIP-ACS-510</td><td>For opening the cranium</td></tr><tr><td>Coagulation Electrode Dura</td><td>DIXI</td><td>KIP-ACS-600</td><td>for opening and coagulating the dura</td></tr><tr><td>Cordless driver</td><td>Stryker</td><td>4405-000-000</td><td>to drive the drill bit</td></tr><tr><td>Leksell Coordinate Frame G</td><td>Elekta</td><td>14611</td><td>For head fixation</td></tr><tr><td>Microdeep Depth Electrode</td><td>DIXI</td><td>D08-**AM</td><td>SEEG electrodes that are implanted, complete with: guide bolt and stylet, as described in manuscript.</td></tr><tr><td>ROSA</td><td>Medtech</td><td>n/a</td><td>stereotactic guidance system with robotic arm, complete with: robotic arm, calibration tool, registration laser, head frame attachment, and software, as described in the manuscript.</td></tr><tr><td>Stylet</td><td>DIXI</td><td>ACS-770S-10</td><td>for creating a path through the parenchyma for the electrode</td></tr></tbody></table>

operative technique and nuances for the stereoelectroencephalographic (seeg) methodology utilizing a robotic stereotactic guidance system

The SEEG methodology has gained favor in North America over the last decade as a means of localizing the epileptogenic zone (EZ) prior to epilepsy surgery. Recently, the application of a robotic stereotactic guidance system for implantation of SEEG electrodes has become more popular in many epilepsy centers. The technique for the use of the robot requires extreme precision in the pre-surgical planning phase and then the technique is streamlined during the operative portion of the methodology, as the robot and surgeon work in concert to implant the electrodes. Herein is detailed precise operative methodology of using the robot to guide implantation of SEEG electrodes. A major limitation of the procedure, namely its heavy reliance on the ability to register the patient to a preoperative volumetric magnetic resonance image (MRI), is also discussed. Overall, this procedure has been shown to have a low morbidity rate and an extremely low mortality rate. The use of a robotic stereotactic guidance system for the implantation of SEEG electrodes is an efficient, fast, safe, and accurate alternative to conventional manual implantation strategies.

The absolute indicator of success following use of the SEEG methodology is seizure freedom for the patient, which ultimately follows successful electrode implantations, successful electrophysiological recordings, as well as successful resection of the EZ. Such a case is shown in Figure 1. Panels A and B of Figure 1 show two tests (single positron emission computed tomography (SPECT) and magnetoelectroencephalography (MEG), respec...

Watch this Scientific Journal Video about Operative Technique and Nuances for the Stereoelectroencephalographic SEEG Methodology Utilizing a Robotic Stereotactic Guidance System at JoVE.com

Operative Technique and Nuances for the Stereoelectroencephalographic SEEG Methodology Utilizing a Robotic Stereotactic Guidance System

The SEEG methodology is simplified and made faster with a stereotactic robot. Careful attention must be paid to the registration of the preoperative volumetric MRI to the patient prior to use of the robot in the OR. The robot streamlines the procedure, leading to decreased operative times and accurate implantations.

Operative Technique and Nuances for the Stereoelectroencephalographic (SEEG) Methodology Utilizing a Robotic Stereotactic Guidance System

The SEEG methodology has gained favor in North America over the last decade as a means of localizing the epileptogenic zone (EZ) prior to epilepsy ...

operative-technique-nuances-for-stereoelectroencephalographic-seeg

Research

JoVE Journal

Behavior

3.5K Views.  Houston Methodist. SEEG, ook bekend als stereo-elektro-encefalografie, is een minimaal invasieve methode voor verkenning van het menselijk brein die rekening houdt met het driedimensionale aspect van de epileptiforme activiteit door de anatomo-elektroklinische correlaties te analyseren. Het belangrijkste voordeel van deze methode is om epileptiforme ontladingen in de hersenen op een minimaal invasieve manier in kaart te brengen. Voordat u met de SEEG-procedure begint, helpt u de patiënt in rugligging.Me...

Video: Operative Technique and Nuances for the Stereoelectroencephalographic SEEG Methodology Utilizing a Robotic Stereotactic Guidance System

Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through implanted electrodes. Deep brain stimulation was first implemented as a therapeutic modality by Benabid et al. in the late 1980s, when he used this technique to stimulate the ventral intermediate nucleus of the thalamus for the treatment of tremor 1. Currently, the procedure is used to treat patients who fail to respond adequately to medical management for diseases such as Parkinson's, dystonia, and essential tremor. The efficacy of this procedure for the treatment of Parkinson's disease has been demonstrated in well-powered, randomized controlled trials 2. Presently, the U.S. Food and Drug Administration has approved DBS as a treatment for patients with medically refractory essential tremor, Parkinson's disease, and dystonia. Additionally, DBS is currently being evaluated for the treatment of other psychiatric and neurological disorders, such as obsessive compulsive disorder, major depressive disorder, and epilepsy. 
DBS has not only been shown to help people by improving their quality of life, it also provides researchers with the unique opportunity to study and understand the human brain. Microelectrode recordings are routinely performed during DBS surgery in order to enhance the precision of anatomical targeting. Firing patterns of individual neurons can therefore be recorded while the subject performs a behavioral task. Early studies using these data focused on descriptive aspects, including firing and burst rates, and frequency modulation 3. More recent studies have focused on cognitive aspects of behavior in relation to neuronal activity 4,5. This article will provide a description of the intra-operative methods used to perform behavioral tasks and record neuronal data with awake patients during DBS cases. Our exposition of the process of acquiring electrophysiological data will illuminate the current scope and limitations of intra-operative human experiments.

Deep brain stimulation surgery offers a unique opportunity to examine information encoding in the awake human brain. This article will describe intra-operative methods used to perform cognitive and behavioral tasks while simultaneously acquiring physiological data such as EMG, single-unit neuronal activity and/or local field potentials.

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through ...

Medicine

A Wireless, Bidirectional Interface for In Vivo Recording and Stimulation of Neural Activity in Freely Behaving Rats

In vivo electrophysiology is a powerful technique to investigate the relationship between brain activity and behavior at a millisecond and micrometer scale. However, current methods mostly rely on tethered cable recordings or only use unidirectional systems, allowing either recording or stimulation of neural activity, but not at the same time or same target. Here, a new wireless, bidirectional device for simultaneous multichannel recording and stimulation of neural activity in freely behaving rats is described. The system operates through a single portable head stage that both transmits recorded activity and can be targeted in real-time for brain stimulation using a telemetry-based multichannel software. The head stage is equipped with a preamplifier and a rechargeable battery, allowing stable long-term recordings or stimulation for up to 1 h. Importantly, the head stage is compact, weighs 12 g (including battery) and thus has minimal impact on the animal&#180;s behavioral repertoire, making the method applicable to a broad set of behavioral tasks. Moreover, the method has the major advantage that the effect of brain stimulation on neural activity and behavior can be measured simultaneously, providing a tool to assess the causal relationships between specific brain activation patterns and behavior. This feature makes the method particularly valuable for the field of deep brain stimulation, allowing precise assessment, monitoring, and adjustment of stimulation parameters during long-term behavioral experiments. The applicability of the system has been validated using the inferior colliculus as a model structure.

A Wireless, Bidirectional Interface for In Vivo Recording and Stimulation of Neural Activity in Freely Behaving Rats

A wireless, bidirectional system for multi-channel neural recordings and stimulation in freely behaving rats is introduced. The system is light and compact, thus having minimal impact on the animal&#180;s behavioral repertoire. Moreover, this bidirectional system provides a sophisticated tool to assess causal relationships between brain activation patterns and behavior.

In vivo electrophysiology is a powerful technique to investigate the relationship between brain activity and behavior at a millisecond and micrometer ...

Building An Open-source Robotic Stereotaxic Instrument

This protocol includes the designs and software necessary to upgrade an existing stereotaxic instrument to a robotic (CNC) stereotaxic instrument for around $1,000 (excluding a drill), using industry standard stepper motors and CNC controlling software. Each axis has variable speed control and may be operated simultaneously or independently. The robot&#39;s flexibility and open coding system (g-code) make it capable of performing custom tasks that are not supported by commercial systems. Its applications include, but are not limited to, drilling holes, sharp edge craniotomies, skull thinning, and lowering electrodes or cannula. In order to expedite the writing of g-coding for simple surgeries, we have developed custom scripts that allow individuals to design a surgery with no knowledge of programming. However, for users to get the most out of the motorized stereotax, it would be beneficial to be knowledgeable in mathematical programming and G-Coding (simple programming for CNC machining).
The recommended drill speed is greater than 40,000 rpm. The stepper motor resolution is 1.8&#176;/Step, geared to 0.346&#176;/Step. A standard stereotax has a resolution of 2.88 &#956;m/step. The maximum recommended cutting speed is 500 &#956;m/sec. The maximum recommended jogging speed is 3,500 &#956;m/sec. The maximum recommended drill bit size is HP 2.

This protocol includes the designs and software necessary to upgrade an existing stereotaxic instrument to a robotic (computer numeric controlled; CNC) stereotaxic instrument for around $1,000 (excluding a drill).

This protocol includes the designs and software necessary to upgrade an existing stereotaxic instrument to a robotic (CNC) stereotaxic instrument for ...

Neuroscience

Investigating the Function of Deep Cortical and Subcortical Structures Using Stereotactic Electroencephalography: Lessons from the Anterior Cingulate Cortex

Stereotactic Electroencephalography (SEEG) is a technique used to localize seizure foci in patients with medically intractable epilepsy. This procedure involves the chronic placement of multiple depth electrodes into regions of the brain typically inaccessible via subdural grid electrode placement. SEEG thus provides a unique opportunity to investigate brain function. In this paper we demonstrate how SEEG can be used to investigate the role of the dorsal anterior cingulate cortex (dACC) in cognitive control. We include a description of the SEEG procedure, demonstrating the surgical placement of the electrodes. We describe the components and process required to record local field potential (LFP) data from consenting subjects while they are engaged in a behavioral task. In the example provided, subjects play a cognitive interference task, and we demonstrate how signals are recorded and analyzed from electrodes in the dorsal anterior cingulate cortex, an area intimately involved in decision-making. We conclude with further suggestions of ways in which this method can be used for investigating human cognitive processes.

Stereotactic Electroencephalography (SEEG) is an operative technique used in epilepsy surgery to help localize seizure foci. It also affords a unique opportunity to investigate brain function. Here we describe how SEEG can be used to investigate cognitive processes in human subjects.

Stereotactic Electroencephalography (SEEG) is a technique used to localize seizure foci in patients with medically intractable epilepsy. This procedure ...

Stereo-Electro-Encephalo-Graphy (SEEG) With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note

SEEG is a method and technique which is used for accurate, invasive recording of seizure activity via three dimensional recordings. In epilepsy patients who are deemed appropriate candidates for invasive recordings, the decision to monitor is made between the subdural grids versus SEEG. Invasive neuromonitoring for epilepsy is pursued in patients with complex, medically refractory epilepsy. The goal of invasive monitoring is to offer resective surgery with the hope of allowing seizure freedom. SEEG&#39;s advantages include access to deep cortical structures, an ability to localize the epileptogenic zone (EZ) when subdural grids have failed to do so, and in patients with non-lesional extra-temporal epilepsies. In this manuscript, we present a succinct historical overview of the SEEG and report on our experience with frameless stereotaxy under robotic. An imperative step of SEEG insertion is planning the electrode trajectories. In order to most effectively record ictal activity via SEEG trajectories should be planned based upon a hypothesis of where the seizure activity originates the presumed epileptogenic zone (EZ). The EZ hypothesis is based on a standardized preoperative workup including video-EEG monitoring, MRI (magnetic resonance imaging), PET (positron emission tomography), ictal SPECT (Single-photon emission computed tomography), and neuropsychological assessment. Using a suspected EZ, SEEG electrodes can be placed minimally invasively yet maintain accuracy and precision. Clinical results showed the ability to localize the EZ in 78% of difficult to localize epileptic patients.1

Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note

Stereo-electroencephalography (SEEG) aids in localization of epileptogenic zones, however, remains relatively underutilized in the United States. The goal of this abstract is to provide a brief introduction to the technique of SEEG and further a detailed technique of using robotic assistance in the placement of SEEG electrodes.

SEEG is a method and technique which is used for accurate, invasive recording of seizure activity via three dimensional recordings. In epilepsy patients ...

Non-restraining EEG Radiotelemetry: Epidural and Deep Intracerebral Stereotaxic EEG Electrode Placement

Implantable EEG radiotelemetry is of central relevance in the neurological characterization of transgenic mouse models of neuropsychiatric and neurodegenerative diseases as well as epilepsies. This powerful technique does not only provide valuable insights into the underlying pathophysiological mechanisms, i.e., the etiopathogenesis of CNS related diseases, it also facilitates the development of new translational, i.e., therapeutic approaches. Whereas competing techniques that make use of recorder systems used in jackets or tethered systems suffer from their unphysiological restraining to semi-restraining character, radiotelemetric EEG recordings overcome these disadvantages. Technically, implantable EEG radiotelemetry allows for precise and highly sensitive measurement of epidural and deep, intracerebral EEGs under various physiological and pathophysiological conditions. First, we present a detailed protocol of a straight forward, successful, quick and efficient technique for epidural (surface) EEG recordings resulting in high-quality electrocorticograms. Second, we demonstrate how to implant deep, intracerebral EEG electrodes, e.g., in the hippocampus (electrohippocampogram). For both approaches, a computerized 3D stereotaxic electrode implantation system is used. The radiofrequency transmitter itself is implanted into a subcutaneous pouch in both mice and rats. Special attention also has to be paid to pre-, peri- and postoperative treatment of the experimental animals. Preoperative preparation of mice and rats, suitable anesthesia as well as postoperative treatment and pain management are described in detail.

Non-restraining EEG radiotelemetry is a valuable methodological approach to record in vivo long-term electroencephalograms from freely moving rodents. This detailed protocol describes stereotaxic epidural and deep intracerebral electrode placement in different brain regions in order to obtain reliable recordings of CNS rhythmicity and CNS related behavioral stages.

Implantable EEG radiotelemetry is of central relevance in the neurological characterization of transgenic mouse models of neuropsychiatric and ...

High-density Electroencephalographic Acquisition in a Rodent Model Using Low-cost and Open-source Resources

Advanced electroencephalographic analysis techniques requiring high spatial resolution, including electrical source imaging and measures of network connectivity, are applicable to an expanding variety of questions in neuroscience. Performing these kinds of analyses in a rodent model requires higher electrode density than traditional screw electrodes can accomplish. While higher-density electroencephalographic montages for rodents exist, they are of limited availability to most researchers, are not robust enough for repeated experiments over an extended period of time, or are limited to use in anesthetized rodents.1-3 A proposed low-cost method for constructing a durable, high-count, transcranial electrode array, consisting of bilaterally implantable headpieces is investigated as a means to perform advanced electroencephalogram analyses in mice or rats.

Procedures for headpiece fabrication and surgical implantation necessary to produce high signal to noise, low-impedance electroencephalographic and electromyographic signals are presented. While the methodology is useful in both rats and mice, this manuscript focuses on the more challenging implementation for the smaller mouse skull. Freely moving mice are only tethered to cables via a common adapter during recording. One version of this electrode system that includes 26 electroencephalographic channels and 4 electromyographic channels is described below.

Instructions for the low-cost construction and surgical implantation of a chronic transcranial high-density electroencephalographic montage into mice are provided. Signal recording, extraction, and processing techniques are also described.

Advanced electroencephalographic analysis techniques requiring high spatial resolution, including electrical source imaging and measures of network ...

Adaptable Angled Stereotactic Approach for Versatile Neuroscience Techniques

Stereotactic surgery is an essential tool in the modern neuroscience lab. However, the ability to precisely and accurately target difficult-to-reach brain regions still presents a challenge, particularly when targeting brain structures along the midline. These challenges include avoiding of the superior sagittal sinus and third ventricle and the ability to consistently target selective and discrete brain nuclei. In addition, more advanced neuroscience techniques (e.g., optogenetics, fiber photometry, and two-photon imaging) rely on targeted implantation of significant hardware to the brain, and spatial limitations are a common hindrance. Presented here is a modifiable protocol for stereotactic targeting of rodent brain structures using an angled coronal approach. It can be adapted to 1) mouse or rat models, 2) various neuroscience techniques, and 3) multiple brain regions. As a representative example, it includes the calculation of stereotactic coordinates for targeting of the mouse hypothalamic ventromedial nucleus (VMN) for an optogenetic inhibition experiment. This procedure begins with the bilateral microinjection of an adeno-associated virus (AAV) encoding a light-sensitive chloride channel (SwiChR++) to a Cre-dependent mouse model, followed by the angled bilateral implantation of fiberoptic cannulae. Using this approach, findings show that activation of a subset of VMN neurons is required for intact glucose counterregulatory responses to insulin-induced hypoglycemia.

Described here is a stereotactic procedure that can target challenging and difficult-to-reach brain regions (due to spatial limitations) using an angled coronal approach. This protocol is adaptable to both mouse and rat models and can be applied to diverse neuroscientific applications, including cannula implantation and microinjections of viral constructs.

Stereotactic surgery is an essential tool in the modern neuroscience lab. However, the ability to precisely and accurately target difficult-to-reach brain ...

In vivo Positron Emission Tomography to Reveal Activity Patterns Induced by Deep Brain Stimulation in Rats

Deep brain stimulation (DBS) is an invasive neurosurgical technique based on the application of electrical pulses to brain structures involved in the patient&#39;s pathophysiology. Despite the long history of DBS, its mechanism of action and appropriate protocols remain unclear, highlighting the need for research aiming to solve these enigmas. In this sense, evaluating the in vivo effects of DBS using functional imaging techniques represents a powerful strategy to determine the impact of stimulation on brain dynamics. Here, an experimental protocol for preclinical models (Wistar rats), combined with a longitudinal study [18F]-fluorodeoxyclucose positron emission tomography (FDG-PET), to assess the acute consequences of DBS on brain metabolism is described. First, animals underwent stereotactic surgery for bilateral implantation of electrodes into the prefrontal cortex. A post-surgical computerized tomography (CT) scan of each animal was acquired to verify electrode placement. After one week of recovery, a first static FDG-PET of each operated animal without stimulation (D1) was acquired, and two days later (D2), a second FDG-PET was acquired while animals were stimulated. For that, the electrodes were connected to an isolated stimulator after administering FDG to the animals. Thus, animals were stimulated during the FDG uptake period (45 min), recording the acute effects of DBS on brain metabolism. Given the exploratory nature of this study, FDG-PET images were analyzed by a voxel-wise approach based on a paired T-test between D1 and D2 studies. Overall, the combination of DBS and imaging studies allows describing the neuromodulation consequences on neural networks, ultimately helping to unravel the conundrums surrounding DBS.

In vivo Positron Emission Tomography to Reveal Activity Patterns Induced by Deep Brain Stimulation in Rats

We describe a preclinical experimental method to evaluate metabolic neuromodulation induced by acute deep brain stimulation with in vivo FDG-PET. This manuscript includes all experimental steps, from stereotaxic surgery to the application of the stimulation treatment and the acquisition, processing, and analysis of PET images.

Deep brain stimulation (DBS) is an invasive neurosurgical technique based on the application of electrical pulses to brain structures involved in the ...

Robotic Cochlear Implantation for Direct Cochlear Access

Robot-assisted systems offer great potential for gentler and more precise cochlear implantation. In this article, we provide a comprehensive overview of the clinical workflow for robotic cochlear implantation using a robotic system specifically developed for a minimally invasive, direct cochlear access. The clinical workflow involves experts from various disciplines and requires training to ensure a smooth and safe procedure. The protocol briefly summarizes the history of robotic cochlear implantation. The clinical sequence is explained in detail, beginning with the assessment of patient eligibility and covering surgical preparation, preoperative planning with the special planning software, drilling of the middle ear access, intraoperative imaging to confirm the trajectory, milling of the inner ear access, insertion of the electrode array, and implant management. The steps that require special attention are discussed. As an example, the postoperative outcome of robotic cochlear implantation in a patient with advanced otosclerosis is presented. Finally, the procedure is discussed in the context of the authors' experience.

Robotic cochlear implantation is a procedure for minimally invasive inner ear access. Compared to conventional surgery, robotic cochlear implantation involves additional steps that need to be carried out in the operating room. In this article we give a description of the procedure and highlight the important aspects of robotic cochlear implantation.

Robot-assisted systems offer great potential for gentler and more precise cochlear implantation. In this article, we provide a comprehensive overview of ...

Operative Technique and Nuances for the Stereoelectroencephalographic (SEEG) Methodology Utilizing a Robotic Stereotactic Guidance System

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