J Neurosurg Pediatr. 2026 Jan 23:1-6. doi: 10.3171/2025.9.PEDS258. Online ahead of print.
ABSTRACT
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.
PMID:41576396 | DOI:10.3171/2025.9.PEDS258
