Name: operative technique and nuances for the stereoelectroencephalographic (seeg) methodology utilizing a robotic stereotactic guidance system
Uploaded: 2023-06-09T13:30:00
Description: Watch this Scientific Journal Video about Operative Technique and Nuances for the Stereoelectroencephalographic SEEG Methodology Utilizing a Robotic Stereotactic Guidance System at JoVE.com

作者没有致谢。

此处使用的所有设备均已获得FDA批准，此处包含的协议构成我们机构的护理标准。因此，该协议的细节不需要IRB批准。
1. 植入前阶段
<ol><li>创建一个解剖电临床 （AEC） 假设。 注意：AEC 假设的创建依赖于多种非侵入性技术的协调来识别潜在的 EZ。包括癫痫科医生、放射科医生和癫痫外科医生在内的专家小组通常会召开会议，讨论每位患者的临床数据，以创建 AEC 假说，该...

<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>

对AEC假说的细致定义以及对植入策略设计的特别关注，最终将决定SEEG方法对每个患者的成功。因此，仔细的术前手术计划至关重要，并且使手术相对简单，风险低。一般来说，最好将轨迹正交于矢状中线，从而促进将来更容易的解剖 - 电生理相关性，并在植入过程中获得更高的精度。但是，在某些情况下可以使用斜轨迹。具体来说，当倾斜轨迹允许对AEC假设中的多个目标进行采样时，这可能是可...

据估计，全球有1500万人患有难治性癫痫1。因此，这些患者中的许多很可能接受手术治疗。癫痫手术依赖于理论上的致痫区（EZ）的精确定位，以指导手术切除。Jean Tailaach和Jean Bancaud在1950年代开发了立体脑电图（SEEG）方法，作为一种基于皮质和深层结构中癫痫脑原 位 电生理学更准确地定位EZ的方法2，3。然而，直到最近，SEEG方法才开始在北美4中获得青睐。
作为SEEG方法的一部分，世界各地使用各种技术和技术，基于不同专业人员和癫痫中心的临床经验5，6，7。然而，最近，用于植入SEEG电极的手术技术已经发展，超越了经典使用基于手动头架的策略。具体来说，使用机器人立体定向引导系统已被证明是SEEG植入的准确替代方案8。具有外科专业知识的人可以安全有效地使用机器人植入，他们正在寻找更快，更自动化的电极植入方法。
本文讨论了使用机器人立体定向引导系统植入SEEG电极时所采取的具体步骤。尽管前面已经描述了SEEG方法，但在此特别注意使用机器人9所采用的手术技术。

<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

在过去的十年中，SEEG方法在北美获得了青睐，作为在癫痫手术前定位致痫区（EZ）的一种手段。最近，机器人立体定向引导系统在植入SEEG电极中的应用在许多癫痫中心变得越来越流行。使用机器人的技术在术前计划阶段需要极高的精度，然后在方法的手术部分简化该技术，因为机器人和外科医生协同工作以植入电极。这里详细介绍了使用机器人来引导SEEG电极植入的精确操作方法。还讨论了该程序的一个主要局限性，即它严重依赖将患者登记在术前体积磁共振图像（MRI）上的能力。总体而言，该手术已被证明具有低发病率和极低死亡率。使用机器人立体定向引导系统植入SEEG电极是传统手动植入策略的高效，快速，安全和准确的替代方案。

使用SEEG方法后成功的绝对指标是患者的无癫痫发作，最终在成功的电极植入，成功的电生理记录以及成功切除EZ之后。 这种情况如图 1 所示。图 1的图 A和B显示了两个测试（分别为单正电子发射计算机断层扫描（SPECT）和磁脑电图（MEG），它们有助于创建AEC假设。但是，关于EZ的识别和后续切除的完成的讨论超出了本文的范围。...

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

使用立体定向机器人简化并加快了SEEG方法。在手术室中使用机器人之前，必须特别注意对患者的术前体积MRI的登记。机器人简化了手术过程，从而减少了手术时间并实现了准确的植入。

利用机器人立体定向引导系统的立体脑电图（SEEG）方法的操作技术和细微差别

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 ...

SEEG也称为立体脑电图，是一种探索人脑的微创方法，通过分析解剖电临床相关性来考虑癫痫样活动的三维方面。这种方法的主要优点是以微创方式绘制大脑中的癫痫样放电。在开始SEEG手术之前，帮助患者进入仰卧位。在患者全身麻醉的情况下，将患者的头部固定在三点固定支架中，并将机器人定位在患者的头部，使机械臂底部与颅骨中点之间的距离为 70 厘米。将机器人锁定到位，并将三点式头架固定在机器人上。使用基于激光的半自动面部识别系统，按照机器人给出的所有提示，向患者注册术前体积MRI。使用设定距离校准工具校准激光，并使用激光手动选择预设的解剖面部特征点。机器人自动扫描面部表面后，将其他独立的表面地标与注册的MRI相关联，以确认配准的准确性。对于螺栓植入，以标准的无菌方式悬垂患者，并用无菌塑料覆盖机器人工作臂。将带有2.5毫米工作套管的钻孔平台连接到机械臂上，并为要植入机器人触摸屏的每个螺栓选择所需的轨迹。踩下机器人踏板，启动机械臂向第一轨迹的运动。当到达正确位置时，手臂将被机器人自动锁定。将两毫米的钻头插入工作套管，并用它来在头骨的整个厚度上创建一个针孔。使用绝缘硬脑膜穿支器在低设置下使用单极烧灼打开硬脑膜。将导向螺栓牢固地拧入每个针孔中，并使用无菌尺子测量从钻孔平台到导向螺栓的距离。从规划轨迹时使用的平台到目标的距离值中减去该测量距离，并记录结果以供以后用作植入电极的最终长度。测量并记下电极的最终长度，并确认它与新计算的螺栓长度相匹配。然后，给电极和螺栓贴上匹配的标签，以防止在电极植入过程中出现混淆。植入所有螺栓后，更换手术手套并打开新的无菌区域。通过导螺栓将直径为两毫米的探针插入电极的预期深度，如植入匹配螺栓后计算的那样。确认要植入的电极与植入的导向螺栓的标签匹配，并取下探针。立即将电极插入螺栓并将电极拧入螺栓进行固定，使用透视X射线确认植入后每个电极的正确放置。当所有电极都植入后，使用标准的头部绷带技术包裹患者的头部。这里展示了一个合适的手术室，该手术室成功地放置了螺栓，并成功植入了SEEG方法的电极。单正电子发射计算机断层扫描和磁脑电图测试有助于创建解剖电临床假说。在这些具有代表性的图像中，电极位于额眼和背岛区域。图中，显示了术后 T1 MRI 中右侧盖膜和岛叶的切除。SEEG方法允许通过应用将深度电极放入人脑的微创技术来三维映射癫痫样活动。

Research

JoVE Journal

Behavior

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

Stereotactic Injection of MicroRNA-expressing Lentiviruses to the Mouse Hippocampus CA1 Region and Assessment of the Behavioral Outcome

立体定向注射的microRNA表达慢病毒的小鼠海马CA1区和行为结果的评估

MicroRNAs (miRNAs) are small regulatory single-stranded RNA molecules around 22 nucleotides long that may each target numerous mRNA transcripts and dim an ...

科研

行为学

Contextual and Cued Fear Conditioning Test Using a Video Analyzing System in Mice

背景和线索恐惧制约试验小鼠中使用视频分析系统

The contextual and cued fear conditioning test is one of the behavioral tests that assesses the ability of mice to learn and remember an association ...

Assessment of Murine Exercise Endurance Without the Use of a Shock Grid: An Alternative to Forced Exercise

小鼠运动耐力的评估没有一个冲击电网的使用：另一种强迫运动

Using laboratory mouse models, the molecular pathways responsible for the metabolic benefits of endurance exercise are beginning to be defined. The most ...

Practical Methodology of Cognitive Tasks Within a Navigational Assessment

认知任务的实用方法在一个导航评估

This paper describes an approach for measuring navigation accuracy relative to cognitive skills. The methodology behind the assessment will thus be ...

Applying Stereotactic Injection Technique to Study Genetic Effects on Animal Behaviors

应用立体定向注射技术在研究动物行为的遗传效应

Stereotactic injection is a useful technique to deliver high titer lentiviruses to targeted brain areas in mice. Lentiviruses can either overexpress or ...

Investigating Motor Skill Learning Processes with a Robotic Manipulandum

调查运动技能的学习过程与机器人Manipulandum

Skilled reaching tasks are commonly used in studies of motor skill learning and motor function under healthy and pathological conditions, but can be ...

Utilizing the Modified T-Maze to Assess Functional Memory Outcomes After Cardiac Arrest

应用改良 T 迷宫评估心脏骤停后的功能记忆结果

Background: Evaluating mild to moderate cognitive impairment in a global cerebral ischemia (i.e. cardiac arrest) model can be difficult due to poor ...

Methodology for Establishing a Community-Wide Life Laboratory for Capturing Unobtrusive and Continuous Remote Activity and Health Data

建立社区范围的生命实验室以捕获不显眼和持续的远程活动和健康数据的方法

An end-to-end suite of technologies has been established for the unobtrusive and continuous monitoring of health and activity changes occurring in the ...

Tickling, a Technique for Inducing Positive Affect When Handling Rats

痒, 一种诱发大鼠正向影响的技术

Handling small animals such as rats can lead to several adverse effects. These include the fear of humans, resistance to handling, increased injury risk ...

A Middle Cerebral Artery Occlusion Technique for Inducing Post-stroke Depression in Rats

Post-stroke depression (PSD) is the most recurrent of all psychiatric complications resulting from an ischemic stroke. A greater majority (about 60%) of ...