OBJECTIVE Electrode placement using robot-assisted stereoelectroencephalography (SEEG) has been proven a safe and accurate technique in children. As its use increases, understanding the impact of registration methods and patient-specific factors on placement accuracy is crucial. The aim of this study was to compare 4 registration methods and to evaluate factors associated with lead placement error. METHODS This retrospective case series included pediatric patients who underwent robot-assisted SEEG from January 2019 to April 2022 at a single institution. Placement accuracy was assessed at both the inner skull table and the prespecified target using 4 registration techniques: 1) laser-based registration with a Mayfield skull clamp (laser), 2) a Leksell frame with bone fiducials (bone fiducials), 3) a Leksell frame with pins plus one bone fiducial (pins+fiducial), and 4) a frame-based registration with etched frame (frame-based). Accuracy differences were analyzed using Kruskal-Wallis and Wilcoxon tests. A stepwise multivariate linear regression model was used to evaluate predictors of error. RESULTS Overall, 231 electrodes were placed in 22 patients (median age 15 years). The median error at the inner skull table was lowest with the pins+fiducial (0.6 mm) technique and highest with the laser (1.7 mm) technique. The target error was also lowest with pins+fiducial (1.1 mm) technique and highest with the laser (2.04 mm) technique. All group differences were statistically significant (p < 0.0001). Younger age (p = 0.0161) and increased bone thickness (p = 0.0304) were independently associated with error at the target and inner skull table, respectively. No clinical complications occurred, including hemorrhage, infection, or electrode malposition. CONCLUSIONS The registration technique used significantly affects robot-assisted SEEG accuracy in children. The use of frame-based approaches, especially using pins and a single fiducial, yielded the highest accuracy. Additional caution should be exercised in younger patients and with trajectories through thicker bone.
Moskalik et al. (Fri,) studied this question.