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F) Telemedicine connection with the “Gómez Ulla” Central Defence Hospital in Madrid.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Navarro Suay, R. García Cañas, S. Castillejo Pérez, E. López Soberón" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Navarro Suay" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "García Cañas" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Castillejo Pérez" ] 3 => array:2 [ "nombre" => "E." 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Pacreu, L. Moltó, J.L. Fernández Candil, E. Vilà" "autores" => array:4 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Pacreu" "email" => array:1 [ 0 => "94397@parcdesalutmar.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Moltó" ] 2 => array:2 [ "nombre" => "J.L." "apellidos" => "Fernández Candil" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Vilà" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesiología y Reanimación y Tratamiento del Dolor, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Implicaciones anestésicas en la colocación de electrodos profundos cerebrales mediante robot estereotáctico en el estudio de epilepsia farmacorresistente" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Epilepsy is a chronic disease with an annual cumulative incidence of 67.77 per 100,000 people.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Pharmacological treatment leads to seizure control in approximately 65% of patients. The remaining 35% suffer from refractory or drug-resistant epilepsy (RDE)<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Due to seizures and antiepileptic drugs (AEDs), RDE is associated with high morbidity and morbidity and a worsening of the patient's quality of life. A pre-surgical evaluation including: video-electroencephalogram (video-EEG), brain magnetic resonance imaging (MRI) and cognitive neurological evaluation should be performed to determine whether a patient who does not respond to medication may benefit from surgery.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Stereo-electroencephalography (SEEG) is an invasive diagnostic technique developed in France by Bancaud and Talairach in the 1960s. It allows the three-dimensional localisation of the epileptogenic zone (EPZ) and to explain the anatomical and topographical origin of seizures. It would be indicated in: (a) patients with epileptiform activity in the 2 temporal regions visible by video-EEG, to assess whether the onset of seizures has a dominant side and, decide to perform or rule out surgery; (b) to delimit the EZ and guide resection surgery when there is discordance between the findings found on MRI and EEG<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>; c) in cases where limited resection is necessary because there is a suspicion that eloquent areas are involved, and d) in patients with multifocal epilepsy where there is doubt about the onset of seizures.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The surgical technique consists of the intracranial implantation of multiple deep microelectrodes using percutaneous microtrepanes for functional brain studies of superficial and deep regions. The advantages of deep electrodes include better spatial resolution, reduced electroencephalographic artefacts and the possibility of performing cortical stimulation for language mapping.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Prior to implantation, angiography is performed and corrected with the structural study of the brain MRI to avoid damaging blood vessels when the electrode is introduced, and the trajectory that the different electrodes will have to follow is planned. In our centre, surgery for SEEG is performed using a stereotactic robot, which provides greater accuracy and speed, and allows more precise trajectories to be planned, reducing the risk of bleeding.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The main and most feared complication is cerebral haemorrhage (less than 5%), which occurs when the electrode is inserted.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> For this reason, a postoperative control computed tomography (CT) scan or brain MRI is performed when the electrodes are implanted and prior to recording the SEEG. Our initial protocol, agreed with Neurosurgery, contemplated performing the control CT scan 6 h after the end of surgery. From 2013 to 2017, 49 surgeries were performed, of which one patient presented epileptic seizures and 4 patients were diagnosed with subdural haematoma with clinical-radiological stability. However, following a case of acute subdural haematoma with severe sequelae (right hemiplegia), which was diagnosed in the Resuscitation Unit due to clinical signs of decreased level of consciousness and which required craniotomy to evacuate the haematoma, it was decided to modify the action protocol in 2017. Pre-surgical cerebral arteriography began to be performed and it was decided to perform a control CT scan at the end of surgery with the patient intubated. Despite the pandemic, 39 surgeries have been performed since then and there have been 2 cases of epidural haematoma, with surgical evacuation of the haematoma being necessary in one patient who did not present postoperative neurological focality. No other complications were recorded. Subsequently, they were transferred to the Resuscitation Unit to wake up and remain under observation for 6 h. Once possible postoperative complications have been ruled out, and if they progress well, they are transferred to the Epilepsy Monitoring Unit, where invasive monitoring is carried out for 14–21 days.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In line with other reviews, the procedure is performed under general anaesthesia.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Monitoring in the operating theatre is standard with non-invasive blood pressure, electrocardiogram and pulse oximetry. The airway approach was performed with a ringed endotracheal tube. Nowadays, coinciding with the change of the robotic system (Neuromate®, Renishaw Mayfield SA, Nyon, Switzerland), which incorporates a stereotactic frame that occupies half of the face, and to have easier access to the airway, a laryngeal mask is placed. Intravenous and halogenated hypnotic drugs can be used in this surgery. The various opioids, as well as neuromuscular blocking agents, are safe. It is important to monitor neuromuscular blockade,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> as these patients take many AEDs, which may interfere with the metabolism of the neuromuscular blocking agents, shortening their duration of action and requiring more frequent administration. Regarding the AEDs that patients take daily, the usual dosage will be continued and oral medication will be prioritised. In addition, once the stereotactic frame is fixed with the robotic system, it is recommended to block the operating theatre bed to avoid injuries derived from its mobilisation.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although SEEG offers better surgical results with fewer complications, when complications occur they can be potentially serious, so it is necessary and important to have an action protocol.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">All the authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:2 [ "identificador" => "xack667603" "titulo" => "Acknowledgements" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and incidence of epilepsy. A systematic review and meta-analysis of international studies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.M. Fiest" 1 => "K.M. Sauro" 2 => "S. Wiebe" 3 => "S.B. Patten" 4 => "C.-S. Kwon" 5 => "J. Dykeman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/WNL.0000000000003509" "Revista" => array:6 [ "tituloSerie" => "Neurology." "fecha" => "2017" "volumen" => "88" "paginaInicial" => "296" "paginaFinal" => "303" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27986877" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The value of diagnostic bilateral intracranial EEG in treatment-resistant focal epilepsy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.C. Hill" 1 => "B.A. Rubin" 2 => "V. Tyagi" 3 => "J. Theobald" 4 => "A. Silverberg" 5 => "M. Miceli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.wneu.2017.01.093" "Revista" => array:7 [ "tituloSerie" => "World Neurosurg." "fecha" => "2017" "volumen" => "103" "paginaInicial" => "1" "paginaFinal" => "10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28185968" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1751991820302539" "estado" => "S300" "issn" => "17519918" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stereoelectroencephalography: surgical methodology, safety, and stereotactic application accuracy in 500 procedures" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Cardinale" 1 => "M. Cossu" 2 => "L. Castana" 3 => "G. Casaceli" 4 => "M.P. Schiariti" 5 => "A. Miserocchi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1227/NEU.0b013e31827d1161" "Revista" => array:6 [ "tituloSerie" => "Neurosurgery." "fecha" => "2013" "volumen" => "72" "paginaInicial" => "353" "paginaFinal" => "366" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23168681" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Electroencephalography in mesial temporal lobe epilepsy: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Javidan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Epilepsy Res Treat." "fecha" => "2012" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is SEEG safe? A systematic review and meta-analysis of stereo-electroencephalography-related complications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.P. Mullin" 1 => "M. Shriver" 2 => "S. Alomar" 3 => "I. Najm" 4 => "J. Bulacio" 5 => "P. Chauvel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/epi.13298" "Revista" => array:6 [ "tituloSerie" => "Epilepsia." "fecha" => "2016" "volumen" => "57" "paginaInicial" => "386" "paginaFinal" => "401" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26899389" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anesthetic considerations for stereotactic electroencephalography implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Rajkalyan" 1 => "A. Tewari" 2 => "S. Rao" 3 => "R. Avitsian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/joacp.JOACP_342_18" "Revista" => array:6 [ "tituloSerie" => "J Anaesthesiol Clin Pharmacol." "fecha" => "2019" "volumen" => "35" "paginaInicial" => "434" "paginaFinal" => "440" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31920225" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack667603" "titulo" => "Acknowledgements" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">Our thanks to the nursing team of our operating theatre (Maria Albert and Francisco de Borja Lavin) for their great help and collaboration to ensure that the operating theatre always works.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Also, to the neurosurgery team (Dr. Alejandra Narvaez and Dr. Nazaret Infante) for their collaboration in data collection.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000007000000004/v1_202305190842/S2341192923000562/v1_202305190842/en/main.assets" "Apartado" => array:4 [ "identificador" => "66474" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000007000000004/v1_202305190842/S2341192923000562/v1_202305190842/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923000562?idApp=UINPBA00004N" ]
