ONS Advance Access: Accuracy and Efficacy for Robotic Assistance in Implanting Responsive Neurostimulation Device Electrodes in Bilateral Mesial Temporal Lobe Epilepsy

Responsive neurostimulation (RNS) is a good option to treat medically refractory focal epilepsy in patients who are not good candidates for resection, such as when ictal onset is close to functional tissue or in the setting of 2 distinct foci (eg, bilateral mesial temporal lobe epilepsy). Forming a closed-loop stimulation system (ie, responsive via feedback), paddle or depth electrodes are implanted in the vicinity of the ictal onset zone and seizures are suppressed by electrically stimulating the epileptogenic focus when epileptiform activity is detected.1 RNS implantation is most commonly performed after localization of the ictal onset zone with invasive monitoring using subdural grids or stereoelectroencephalography (SEEG). RNS has been shown to be an excellent option in patients with bilateral mesial temporal lobe epilepsy.2,3

The use of robotic assistance in stereotactic procedures has become more popular recently. Robotic assistance has been used in a variety of procedures, including deep brain stimulation (DBS),4 laser ablation,5,6 and SEEG,7 and has proven to be an effective tool that excels with spatial information, allowing for accurate and precise placement of electrodes.5 Robot assistance also allows for creation of trajectories that are difficult with frame-based systems and also removes the risks of human error associated with calculations and trajectory planning.7

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