251. Robotic Rehearsal for Stereoencephalography: Combining 3D-Printing Technology with Preoperative Stereotactic Planning for Placement of Intracranial Depth Electrodes

Authors: David Bonda, MD; Rachel Pruitt, MD; Todd Goldstein, PhD; Anish Varghese, MS; Amar Shah, MD; Shaun Rodgers, MD (Port Washington, NY)

Introduction:

Frameless stereotactic robotic technology has become increasingly ubiquitous since the FDA approval of the Robotic Surgical Assistant (ROSA) in 2012. While the use of the ROSA robot has greatly augmented stereotactic placement of intracranial depth electrodes for the purposes of epileptogenic focus identification, the preoperative planning stages remain limited to computer software. We describe the use of custom-made, 3D-printed patient models in the preoperative planning of robot-assisted depth electrode placement for epilepsy monitoring in nine pediatric patients with a total of 110 electrodes.

Methods:

Anatomically accurate, custom-made 3D models were created by our Center for 3D Design and Innovation prior to each case. In a preoperative rehearsal session, each model was registered, positioned, and pinned using the ROSA platform. After standard software-based electrode trajectory planning, depth electrodes were sequentially placed in each 3D model with a focus on maximizing efficiency and minimizing potential intraoperative conflicts.

Results:

Utilization of the 3D-printed model enabled workflow optimization and early recognition of difficulties with patient positioning, registration, and electrode insertion. Consequently, average lead placement time during the real operation was six minutes per lead; we achieved these results without the need for a single intraoperative trajectory change and without any registration errors/do-overs, postoperative complications, or electrode inaccuracies. The total production cost of each model, including labor and parts, was $35.00 (USD). Considering the reduction in operative time provided by the increase in efficiency (45 minutes per case, on average), we estimate an overall cost savings of over $6500 per case.

Conclusion:

Our use of 3D-printed patient models greatly enhances presurgical positioning and trajectory planning in the placement of stereotactic depth electrodes for epilepsy monitoring in pediatric patients. The rehearsal session decreases operative time and increases efficiency of electrode placement, resulting in increased patient safety and cost-savings.