ArticleActa neurochirurgica2026
How I do it: a standardized robotic workflow for image-guided stereo-electroencephalography: technical description and institutional experience.
Article in Acta neurochirurgica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundStereo-electroencephalography (SEEG) is a key technique for the presurgical evaluation of drug-resistant focal epilepsy [2]. Robotic assistance facilitates precise multi-trajectory stereotactic implantation and allows workflow standardization [1, 3, 5, 9]. We describe a reproducible image-based robotic SEEG implantation protocol and report our institutional experience.
methodsAn image-based robot-assisted SEEG technique using the Neuromate® system combined with intraoperative 3D imaging is presented. The workflow includes hypothesis-driven trajectory planning, alphabetical trajectory sequencing, laser-verified stereotactic registration, trajectory-specific skull thickness measurement with depth-controlled drilling, reducer-guided bolt placement, and intraoperative imaging verification. Institutional procedural data were reviewed to illustrate workflow performance and safety.
resultsSixty-eight patients underwent implantation of 952 SEEG depth electrodes (mean 14 electrodes per patient). Mean robotic implantation time was 198 min (SD 54.9; range 80-280), corresponding to 14.1 min per electrode. Mean stereotactic registration error was 1.7 mm. Three patients (4.4%) developed intracranial hemorrhage, with one symptomatic case (1.47%) requiring surgical evacuation. This event occurred during electrode removal rather than implantation. No hemorrhage occurred during robotic electrode insertion, and no electrode repositioning or reintervention was required.
conclusionImage-based robot-assisted SEEG enables accurate and reproducible multi-trajectory implantation with efficient workflow and low complication rates. Structured trajectory planning and systematic intraoperative verification may improve procedural safety and standardization.
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