Usefulness of Robotic Stereotactic Assistance (ROSA®) Device for Stereoelectroencephalography Electrode Implantation: A Systematic Review and Meta-analysis

Abstract

The aim of this study was to systematically review and meta-analyze the efficiency and safety of using the Robotic Stereotactic Assistance (ROSA^®) device (Zimmer Biomet; Warsaw, IN, USA) for stereoelectroencephalography (SEEG) electrode implantation in patients with drug-resistant epilepsy. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was carried out. Overall, 855 nonduplicate relevant articles were determined, and 15 of them were selected for analysis. The benefits of the ROSA^® device use in terms of electrode placement accuracy, as well as operative time length, perioperative complications, and seizure outcomes, were evaluated. Studies that were included reported on a total of 11,257 SEEG electrode implantations. The limited number of comparative studies hindered the comprehensive evaluation of the electrode implantation accuracy. Compared with frame-based or navigation-assisted techniques, ROSA^®-assisted SEEG electrode implantation provided significant benefits for reduction of both overall operative time (mean difference [MD], -63.45 min; 95% confidence interval [CI] from -88.73 to -38.17 min; P < 0.00001) and operative time per implanted electrode (MD, -8.79 min; 95% CI from -14.37 to -3.21 min; P = 0.002). No significant differences existed in perioperative complications and seizure outcomes after the application of the ROSA^® device and other techniques for electrode implantation. To conclude, the available evidence shows that the ROSA^® device is an effective and safe surgical tool for trajectory-guided SEEG electrode implantation in patients with drug-resistant epilepsy, offering benefits for saving operative time and neither increasing the risk of perioperative complications nor negatively impacting seizure outcomes.

Keywords: Robotic Stereotactic Assistance (ROSA®); depth electrode implantation; efficacy; epilepsy; stereoelectroencephalography.

Fig. 1

PRISMA flow diagram of the systematic review and meta-analysis.

Fig. 2

Forest plots of operative time differences between various techniques of stereoelectroencephalography electrode implantation. The use of ROSA^® provided a statistically significant reduction of both overall operative time (A) and operative time per implanted electrode (B).

Fig. 3

Forest plots of perioperative complication rates between various techniques of stereoelectroencephalography electrode implantation. The use of ROSA^® was not associated with a significantly different number of complications (A) or intracerebral hemorrhage (B).

Fig. 4

Forest plots of proportions of cases with subsequent stereoelectroencephalography-guided resections (A) and Engel Class I outcomes (B) do not demonstrate significant differences between various techniques of depth electrode implantation.