J Neurol Surg A Cent Eur Neurosurg 2021; 82(02): 125-129
DOI: 10.1055/s-0040-1720998
Original Article

Robotic Navigated Laser Craniotomy for Depth Electrode Implantation in Epilepsy Surgery: A Cadaver Lab Study

Karl Roessler
1   Department of Neurosurgery, Medical University of Vienna, Wien, Austria
,
Fabian Winter
1   Department of Neurosurgery, Medical University of Vienna, Wien, Austria
,
Tobias Wilken
2   Advanced Osteotomy Tools, AOT, Basel, Switzerland
,
Ekaterina Pataraia
3   Department of Neurological Clinic, Medical University of Vienna, Wien, Austria
,
Magdalena Mueller-Gerbl
4   Department of Anatomy, University of Basel, Basel, BS, Switzerland
,
1   Department of Neurosurgery, Medical University of Vienna, Wien, Austria
› Author Affiliations

Abstract

Objective Depth electrode implantation for invasive monitoring in epilepsy surgery has become a standard procedure. We describe a new frameless stereotactic intervention using robot-guided laser beam for making precise bone channels for depth electrode placement.

Methods A laboratory investigation on a head cadaver specimen was performed using a CT scan planning of depth electrodes in various positions. Precise bone channels were made by a navigated robot-driven laser beam (erbium:yttrium aluminum garnet [Er:YAG], 2.94-μm wavelength,) instead of twist drill holes. Entry point and target point precision was calculated using postimplantation CT scans and comparison to the preoperative trajectory plan.

Results Frontal, parietal, and occipital bone channels for bolt implantation were made. The occipital bone channel had an angulation of more than 60 degrees to the surface. Bolts and depth electrodes were implanted solely guided by the trajectory given by the precise bone channels. The mean depth electrode length was 45.5 mm. Entry point deviation was 0.73 mm (±0.66 mm SD) and target point deviation was 2.0 mm (±0.64 mm SD). Bone channel laser time was ∼30 seconds per channel. Altogether, the implantation time was ∼10 to 15 minutes per electrode.

Conclusion Navigated robot-assisted laser for making precise bone channels for depth electrode implantation in epilepsy surgery is a promising new, exact and straightforward implantation technique and may have many advantages over twist drill hole implantation.



Publication History

Received: 23 February 2020

Accepted: 08 June 2020

Article published online:
05 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Roessler K, Sommer B, Merkel A. et al. A frameless stereotactic implantation technique for depth electrodes in refractory epilepsy using intraoperative magnetic resonance imaging. World Neurosurg 2016; 94: 206-210
  • 2 Dorfer C, Minchev G, Czech T. et al. A novel miniature robotic device for frameless implantation of depth electrodes in refractory epilepsy. J Neurosurg 2017; 126 (05) 1622-1628
  • 3 Dorfer C, Stefanits H, Pataraia E. et al. Frameless stereotactic drilling for placement of depth electrodes in refractory epilepsy: operative technique and initial experience. Neurosurgery 2014; 10 (Suppl. 04) 582-590 , discussion 590–591
  • 4 Cardinale F, Cossu M, Castana L. et al. Stereoelectroencephalography: surgical methodology, safety, and stereotactic application accuracy in 500 procedures. Neurosurgery 2013; 72 (03) 353-366 , discussion 366
  • 5 Cardinale F, Casaceli G, Raneri F, Miller J, Lo Russo G. Implantation of stereoelectroencephalography electrodes: a systematic review. J Clin Neurophysiol 2016; 33 (06) 490-502
  • 6 Augello M, Baetscher C, Segesser M, Zeilhofer HF, Cattin P, Juergens P. Performing partial mandibular resection, fibula free flap reconstruction and midfacial osteotomies with a cold ablation and robot-guided Er:YAG laser osteotome (CARLO®): a study on applicability and effectiveness in human cadavers. J Craniomaxillofac Surg 2018; 46 (10) 1850-1855
  • 7 Augello M, Deibel W, Nuss K, Cattin P, Jürgens P. Comparative microstructural analysis of bone osteotomies after cutting by computer-assisted robot-guided laser osteotome and piezoelectric osteotome: an in vivo animal study. Lasers Med Sci 2018; 33 (07) 1471-1478
  • 8 Berg BI, Peyer M, Kuske L. et al. Comparison of an Er: YAG laser osteotome versus a conventional drill for the use in osteo-odonto-keratoprosthesis (OOKP). Lasers Surg Med 2019; 51 (06) 531-537
  • 9 Lukac N, Suhovršnik T, Lukac M, Jezeršek M. Ablation characteristics of quantum square pulse mode dental erbium laser. J Biomed Opt 2016; 21 (01) 15012
  • 10 Baek KW, Deibel W, Marinov D. et al. A comparative investigation of bone surface after cutting with mechanical tools and Er:YAG laser. Lasers Surg Med 2015; 47 (05) 426-432