Use of the Globus ExcelsiusGPS System for Robotic Stereoelectroencephalography: An Initial Experience

Background: Stereoelectroencephalography (SEEG) is a critical tool used in the identification of epileptogenic zones. Although stereotactic frame-based SEEG procedures have been performed traditionally, newer robotic-assisted SEEG procedures have become increasingly common. In this study, we evaluate the accuracy, efficacy of the ExcelsiusGPS robot (Globus Medica, Audubon, PA) in SEEG procedures. Methods: Five consecutive adult patients with drug resistant epilepsy were identified as SEEG candidates via a multidisciplinary epilepsy surgery committee. Preoperative scans were merged onto the robot to plan electrode placement. With the use of a camera system, dynamic reference base, and surveillance markers, the robotic arm was used to establish the trajectory of the electrodes. Postoperative computed tomography (CT) scans were merged onto the preoperatively planned trajectory and the radial, depth, and entry errors were calculated. Fiducial registration error was calculated for 4 cases to determine error between the patient and intraoperative CT merge. Results: A total of 59 electrodes were placed. The mean age at surgery was 41.6 ± 15.1 years. Mean operating room time, anesthesia time, and surgical time was 301.6 ± 44.4 min, 261.6 ± 50.2 min, and 155.8 ± 48.8 min, respectively. The overall mean depth, radial, and entry errors were 2.5 ± 1.9 mm, 1.9 ± 1.5 mm, and 1.6 ± 1.2 mm. Mean fiducial registration error retrospectively calculated for 4 of 5 cases was 0.13 ± 0.04 mm. There were no perioperative complications. Conclusions: The initial performance of the ExcelsiusGPS robotic system yielded comparable results to other systems currently in use for adult SEEG procedures.