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The clinical application of neuro-robot in the resection of epileptic foci: a novel method assisting epilepsy surgery

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Abstract

During surgery for foci-related epilepsy, neurosurgeons face significant difficulties in identifying and resecting MRI-negative or deep-seated epileptic foci. Here, we present a neuro-robotic navigation system that is specifically designed for resection of MRI negative epileptic foci. We recruited 52 epileptic patients, and randomly assigned them to treatment group with either neuro-robotic navigation or conventional neuronavigation system. For each patient, in the neuro-robotic navigation group, we integrated multimodality imaging including MRI and PET-CT into the robotic workstation and marked the boundary of foci from the fused image. During surgery, this boundary was delineated by the robotic laser device with high accuracy, guiding resection for the surgeon. For deeply seated foci, we exploited the neuro-robotic navigation system to localize the deepest point with biopsy needle insertion and methylene dye application to locate the boundary of the foci. Our results show that, compared with the conventional neuronavigation, the neuro-robotic navigation system performs equally well in MRI positive epilepsy patients (ENGEL I ratio: 71.4% vs 100%, p = 0.255) systems and show better performance in patients with MRI-negative focal cortical dysplasia (ENGEL I ratio: 88.2% vs 50%, p = 0.0439). At present, there are no documented neurosurgery robots with similar function and application in the field of epilepsy. Our research highlights the added value of using neuro-robotic navigation systems in resection surgery for epilepsy, particularly in cases that involve MRI-negative or deep-seated epileptic foci.

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Data availability

All data in this study are available from the corresponding author upon reasonable request after approval of local IRB.

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Acknowledgements

We are grateful to ChenYu Wang, DePeng Zhao, and YuBing Zhang for their expert technical assistance.

Funding

This work was supported by the Scientific Research Common Program of the Beijing Municipal Commission of Education (No. KZ201510025029), the National Natural Science Foundation of China (No. 81870888 and 61761166004), and the Capital Medical Development Scientific Research Project (No. 2018-2Z-1076).

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Author notes

  1. Yichen Xu and Yingchuan Chen have contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China

    Yichen Xu, Yingchuan Chen, Huanguang Liu, Hua Zhang, Zixiao Yin, Defeng Liu, Guanyu Zhu, Yu Diao, Delong Wu, Hutao Xie, Wenhan Hu, Xin Zhang, Kai Zhang, Jianguo Zhang & Anchao Yang

  2. Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China

    Xin Zhang, Jianguo Zhang & Anchao Yang

  3. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China

    Xiaoqiu Shao

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  1. Yichen Xu
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Contributions

All authors of this manuscript actively participated in data acquisition, commented on drafts of the manuscript, and approved its final version. YX and YC drafted the initial manuscript and reviewed the literature. HL, HZ, and WH collected the data. YZ, GZ, SX, and KZ oversaw follow-up and assessments of the patients. DL, YD, HX and DW analyzed the data and performed the statistical analysis. XZ prepared the materials. AY and JZ designed the study and revised the manuscript.

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Correspondence to Jianguo Zhang or Anchao Yang.

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Xu, Y., Chen, Y., Liu, H. et al. The clinical application of neuro-robot in the resection of epileptic foci: a novel method assisting epilepsy surgery. J Robotic Surg 17, 2259–2269 (2023). https://doi.org/10.1007/s11701-023-01615-w

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