Mr. Zhou (pseudonym), 52 years old from Hunan, has had strange behavior since childhood, manifested as hazy consciousness, one-eyed blinking, hands groping everywhere, severe limb twitching, mouth foam, basically dozens of attacks a month, which makes Mr. Zhou very painful.
After going to many large hospitals, all diagnosed with epilepsy, it is recommended to take medication for conservative treatment, but taking drugs for decades has not seen results. This made him very anxious, did not dare to drive, could not swim, and could not even go out alone, and after being introduced by the patient group, he was recently treated at the Epilepsy Center of Hunan Provincial Brain Hospital (Hunan Second People's Hospital).
Dr. Li Zhenguang of the Epilepsy Center improved the 3.0T NMR epilepsy sequence scan for the patient to find the cause, which greatly improved the detection rate of lesions in the brain of epilepsy patients, and found that there was an abnormal signal in Mr. Zhou's left insular lobe, and his video EEG also suggested a discharge at the left lesion.
During surgery, the robot guides the implantation of intracranial electrodes
Chief Physician Lu Jun, chief physician of the department, organized the expert team Zeng Qichang, Li Zhenguang, Wang Qin, peng Qiong to conduct preoperative discussions, combined with the patient's seizure symptoms, medical history, EEG and MRI, PETCT and other images, and carried out multimodal image fusion, considering the patient's left isola leaf suspicious cortical dysplasia lesion as Mr. Zhou's epilepsy lesion is likely, but the lesion location is deep and the risk of resection is high, it is recommended that the robot assist the implantation of the lower intracranial electrode, and combine the stereotactic electrode to perform radiofrequency destruction of epilepsy lesions after surgery.
Precise localization of the epileptic lesion is the key to achieving good surgical results. This is the first time that the Epilepsy Center of Hunan Brain Hospital has used surgical robot navigation to complete intracranial electrode implantation. The robot can quickly complete the accurate matching of the image space and the patient's surgical space, and the surgeon confirms that the positioning accuracy of the robot system is within 0.5 mm with the help of random verification points, ensuring that the positioning accuracy of the whole process meets the requirements of the operation. One by one, six deep electrodes were implanted into the patient's suspected epilepsy lesion location. Each electrode takes an average of 5 minutes and the system positioning accuracy is within 0.05 mm. This will greatly shorten the surgical time and implant accuracy of electrode implantation.
After the operation on December 16, Mr. Zhou did not have any surgical discomfort, and the next step will be to use stereotactic EEG monitoring to more accurately determine the epileptic foci and facilitate the next step of electrode destruction.
Chief Physician Lu Jun introduced that Hunan Brain Hospital has taken the lead in the province to carry out stereotactic electroencephalography technology (SEEG), through minimally invasive methods to put electrodes into the brain, comprehensively monitor the origin, spread and symptom generation of epilepsy, analyze the "epilepsy 3D network", provide more accurate epilepsy surgical positioning, and under the guidance of stereotactic EEG, use the principle of radiofrequency to destroy epilepsy lesions and achieve the purpose of curing epilepsy. "If you want to do something well, you must first use it", and now we have a sharp weapon, successfully carrying out stereotactic intracranial electrode implantation with robot assistance, bringing patients a precise, rapid and high-tech experience, and will also be a new direction for the minimally invasive development of epilepsy surgery.
Huang Hongxing, chief physician of the Department of Neurosurgery, said that in traditional stereotactic surgery, doctors only determine the location of lesions through a single CT or MRI image and plan the surgical path. In this way, it is difficult to locate lesions, inability to locate important functional tissues, and inability to locate intracranial blood vessels, resulting in a high risk of intracranial hemorrhage. At present, the visualization technology of 3D multimodal images can effectively solve the above problems. Based on multimodal image fusion technology, the intracranial vascular structure can be fully displayed, which can effectively help doctors avoid important vascular planning puncture paths, so as to form a targeted and personalized stereotactic surgical plan. In the future, neurosurgical robots will be more safe, accurate and effectively used in the surgical treatment of a variety of neurosurgical diseases, such as epilepsy, Parkinson's disease, idiopathic tremor, dystonia, brain tissue biopsy, cerebral hematoma removal, neural navigation, etc., which will benefit the majority of patients.
Contributed by: Epilepsy Center Peng Qiong
Photo: Jiang Quanqian
Editor: Shi Rong