Robot-assisted versus frame-based stereoelectroencephalography (sEEG) electrode implantation in drug-resistant epilepsy: a meta-analysis of accuracy, efficiency, and safety

Abstract

Objective: To compare the accuracy, efficiency, and safety of robot-assisted versus frame-based stereoelectroencephalography (sEEG) in patients with drug-resistant epilepsy. Methods: In accordance with the PRISMA guidelines, a comprehensive literature search was conducted across four databases (PubMed, Scopus, Web of Science, and Cochrane) up to September 2025. We included comparative studies that evaluated robot-assisted versus frame-based sEEG in patients with drug-resistant epilepsy. A random-effects model was applied to calculate the mean difference (MD) and risk ratio (RR) with corresponding 95% confidence intervals (CI). Results: Eight retrospective comparative cohort studies (758 patients) were included. Regarding accuracy, there was no significant difference between the robot-assisted and frame-based sEEG in depth error (MD: 0.24 mm; 95% CI: -0.79 to 1.27), radial error (MD: 0.07 mm; 95% CI: -0.70 to 0.84), entry point error (EPE; MD: -1.35 mm; 95% CI: -2.74 to 0.04), and target point error (MD: -0.02 mm; 95% CI: -0.57 to 0.53). Robot-assisted sEEG demonstrated a significantly shorter overall operation time (MD: -32.58 min; 95% CI: -47.92 to -17.24) and operation time per electrode (MD: -6.55 min; 95% CI: -8.08 to -5.02). However, pre-implantation time (MD: -1.46 min; 95% CI: -14.02 to 11.11) and electrode number per patient (MD: 0.86; 95% CI: -0.84 to 2.56) were comparable between groups. There was no significant difference between the two groups in overall complication rates, including hemorrhagic events, neurological deficits, infections, and technical complications. Conclusion: Robot-assisted sEEG significantly reduced both overall operation time and operation time per electrode compared with the frame-based group. Both techniques demonstrated comparable accuracy and safety profiles.