机器人立体定向辅助系统在癫痫外科深部电极植入中的应用价值

目的研究神经外科机器人立体定向辅助系统（robotized stereotactic assistant，ROSA）在癫痫外科中的应用价值。方法自2013年3月至6月，对11例顽固性癫痫患者，经过电一临床症状学、影像学、头皮脑电图等无创手段严谨的术前评估，设计颅内电极埋置方案。在ROSA引导下，定向植入脑深部电极。埋置电极后进行颅内脑电图长程监测，最终手术治疗。结果11例患者平均年龄26．3岁（13～48岁），平均病史11．9年（1～23年）。共植入72根深部电极，1例患者进行单侧植入，10例系双侧植入。其中包括额叶17根，颞叶52根，岛叶3根。平均每根电极植入时间小于10分钟。术后复查CT，与术前MRI相融合之后分析，可见各电极末端位置与植入术前计划靶点位置基本一致，平均位置误差1．7mm（0．3～3．1mm）。1例患者在电极入路点有少量蛛网膜下腔出血，仅表现轻微头痛。本组患者均无显著的颅内出血等并发症发生。结论ROSA引导植入脑深部电极应用于顽固性癫痫的外科治疗，克服了传统的框架式立体定向仪应用的局限性，更加安全、精准、便捷。

The application of robotized stereotactic assistant for depth electrodes implantation in epilepsy surgery

Objective The aim of this research is to study the value of robotized stereotac- tic assistant （ROSA） in epilepsy surgery. Methods Eleven patients with medical intractable epi- lepsy were involved in our study from March 2013 to June 2013. We designed electrode implantation plan for each patient who underwent rigorous preoperative evaluations through non--invasive investigations like electro--clinical manifestations,imaging data and video--EEG. With the help of the ROSA, deep electrode implantation was performed as we conceived preoperatively in these patients. All the patients obtained operations after postoperative EEG monitoring. Results The patients＇ age ranged from 13-48 years, with averge age 26.3 years. 72 deep electrodes were implanted in total. They were as follow： frontal lobe （n = 17）, temporal lobe （n = 52） and insular lobe （n=3）. The averge time to implant one electrode is less than ten minutes, we performed CT --scan for every patient after operation and made the CT--scan and preoperative MRI fusion in order to visualize the electrode in our respective targets. Postoperative complications were rare in this group,only one person suffered from subarachnoid hemorrhage and felt little headache. Conclusion ROSA overcomes the limitations of the tradtional stereotaxic frame in the application of electrode implantation for surgical treatment of epilepsy and will become more secure, accurate and convenient.