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Spennato P, Di Costanzo M, Mirone G, Cicala D, De Martino L, Onorini N, Ruggiero C, Cinalli G. Image-guided biopsy of intracranial lesions in children, with a small robotic device: a case series. Childs Nerv Syst 2024; 40:1681-1688. [PMID: 38441630 DOI: 10.1007/s00381-024-06349-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/28/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND AND OBJECTIVES Robot-assisted biopsies have gained popularity in the last years. Most robotic procedures are performed with a floor-based robotic arm. Recently, Medtronic Stealth Autoguide, a miniaturized robotic arm that work together with an optical neuronavigation system, was launched. Its application in pediatric cases is relatively unexplored. In this study, we retrospectively report our experience using the Stealth Autoguide, for frameless stereotactic biopsies in pediatric patients. METHODS Pediatric patients who underwent stereotactic biopsy using the Stealth Autoguide cranial robotic platform from July 2020 to May 2023 were included in this study. Clinical, neuroradiological, surgical, and histological data were collected and analyzed. RESULTS Nineteen patients underwent 20 procedures (mean age was 9-year-old, range 1-17). In four patients, biopsy was part of a more complex surgical procedure (laser interstitial thermal therapy - LITT). The most common indication was diffuse intrinsic brain stem tumor, followed by diffuse supratentorial tumor. Nine procedures were performed in prone position, eight in supine position, and three in lateral position. Facial surface registration was adopted in six procedures, skull-fixed fiducials in 14. The biopsy diagnostic tissue acquisition rate was 100% in the patients who underwent only biopsy, while in the biopsy/LITT group, one case was not diagnostic. No patients developed clinically relevant postoperative complications. CONCLUSION The Stealth Autoguide system has proven to be safe, diagnostic, and highly accurate in performing stereotactic biopsies for both supratentorial and infratentorial lesions in the pediatric population.
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Affiliation(s)
- Pietro Spennato
- Department of Neurosciences, Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy.
| | - Marianna Di Costanzo
- Department of Neurosciences, Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Giuseppe Mirone
- Department of Neurosciences, Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Domenico Cicala
- Department of Neurosciences, Division of Neuroradiology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Lucia De Martino
- Department of Onco-Hematology, Unit of Neuro-oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Nicola Onorini
- Department of Neurosciences, Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Claudio Ruggiero
- Department of Neurosciences, Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Giuseppe Cinalli
- Department of Neurosciences, Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
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Cai D, Wang X, Hu W, Mo J, Liu H, Li X, Zheng X, Ding X, An J, Hua Y, Zhang J, Zhang K, Zhang C. The 3-Dimensional Intelligent Structured Light Technique: A New Registration Method in Stereotactic Neurosurgery. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01145. [PMID: 38687040 DOI: 10.1227/ons.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/28/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Surface-based facial scanning registration emerged as an essential registration method in the robot-assisted neuronavigation surgery, providing a marker-free way to align a patient's facial surface with the imaging data. The 3-dimensional (3D) structured light was developed as an advanced registration method based on surface-based facial scanning registration. We aspire to introduce the 3D structured light as a new registration method in the procedure of the robot-assisted neurosurgery and assess the accuracy, efficiency, and safety of this method by analyzing the relative operative results. METHODS We analyzed the results of 47 patients who underwent Ommaya reservoir implantation (n = 17) and stereotactic biopsy (n = 30) assisted by 3D structured light at our hospital from January 2022 to May 2023. The accuracy and additional operative results were analyzed. RESULTS For the Ommaya reservoir implantation, the target point error was 3.2 ± 2.2 mm and the entry point error was 3.3 ± 2.4 mm, while the operation duration was 35.8 ± 8.3 minutes. For the stereotactic biopsy, the target point error was 2.3 ± 1.3 mm and the entry point error was 2.7 ± 1.2 mm, while the operation duration was 24.5 ± 6.3 minutes. CONCLUSION The 3D structured light technique reduces the patients' discomfort and offers the advantage of a simpler procedure, which can improve the clinical efficiency with the sufficient accuracy and safety to meet the clinical requirements of the puncture and navigation.
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Affiliation(s)
- Du Cai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenhan Hu
- Department of Neuroelectrophysiology, Beijing Neurosurgical Institute, Beijing, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huanguang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiaoyan Li
- Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xixi Zheng
- Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaosheng Ding
- Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Juan An
- Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yichun Hua
- Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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Lee TK, Lim SH, Jeong J, Park SJ, Kim YJ, Moon KS, Kim IY, Jung S, Jung TY. Leksell Frame-Based Stereotactic Biopsy for Infratentorial Tumor : Practical Tips and Considerations. J Korean Neurosurg Soc 2024; 67:249-256. [PMID: 38211582 PMCID: PMC10924902 DOI: 10.3340/jkns.2023.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 01/13/2024] Open
Abstract
The Leksell frame-based transcerebellar approach was proposed with the arc support frame attached upside down to the Z coordinate. This study presented practical tips and considerations for obtaining adequate tissue samples for deep-seated cerebellar lesions or lower brainstem lesions specifically those accessible via the cerebellar peduncle. For practical insights, the Leksell coordinate frame G was fixed to prevent the anterior screw implantation within the temporalis muscle, to avoid interference with the magnetic resonance (MR)-adapter, and taking into account the magnetic field of MR in close proximity to the tentorium. After mounting of indicator box, the MR imaging evaluation should cover both the indicator box and the infratentorial region that deviated from it. The coordinates [X, Y, Za, Arc0, Ringa0] obtained from Leksell SurgiPlan® software (Elekta, Stockholm, Sweden) with arc 00 located on the patient's right side were converted to [X, Y, Zb=360-Za, Arc0, Ringb0=Ringa0-1800]. The operation was performed in the prone position under general anesthesia in four patients with deep cerebellar (n=3) and brainstem (n=1) tumors. The biopsy results showed two cases of diffuse large B-cell lymphoma, one metastatic braintumor and one glioblastoma. One patient required frame repositioning as a complication. Drawing upon the methodology outlined in existing literature, we anticipate that imparting supplementary expertise could render the stereotactic biopsy of infratentorial tumors more consistent and manageable for the practitioner, thereby facilitating adequate tissue samples and minimizing patient complications.
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Affiliation(s)
- Tae-Kyu Lee
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Sa-Hoe Lim
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jangshik Jeong
- Department of Biomedical Engineering, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Su Jee Park
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Yeong Jin Kim
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - In-Young Kim
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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Leclerc A, Deboeuf L, Elia A, Aboubakr O, Planet M, Bedioui A, Rault F, Faisant M, Roux A, Simboli GA, Moiraghi A, Gaberel T, Pallud J, Emery E, Zanello M. Safety and efficacy of frameless stereotactic robot-assisted intraparenchymal brain lesion biopsies versus image-guided biopsies: a bicentric comparative study. Acta Neurochir (Wien) 2024; 166:67. [PMID: 38319393 DOI: 10.1007/s00701-024-05912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/06/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE User-friendly robotic assistance and image-guided tools have been developed in the past decades for intraparenchymal brain lesion biopsy. These two methods are gradually becoming well accepted and are performed at the discretion of the neurosurgical teams. However, only a few data comparing their effectiveness and safety are available. METHODS Population-based parallel cohorts were followed from two French university hospitals with different surgical methods and defined geographical catchment regions (September 2019 to September 2022). In center A, frameless robot-assisted stereotactic intraparenchymal brain lesion biopsies were performed, while image-guided intraparenchymal brain lesion biopsies were performed in center B. Pre-and postoperative clinical, radiological, and histomolecular features were retrospectively collected and compared. RESULTS Two hundred fifty patients were included: 131 frameless robot-assisted stereotactic intraparenchymal brain lesion biopsies in center A and 119 image-guided biopsies in center B. The clinical, radiological, and histomolecular features were comparable between the two groups. The diagnostic yield (96.2% and 95.8% respectively; p = 1.000) and the overall postoperative complications rates (13% and 14%, respectively; p = 0.880) did not differ between the two groups. The mean duration of the surgical procedure was longer in the robot-assisted group (61.9 ± 25.3 min, range 23-150) than in the image-guided group (47.4 ± 11.8 min, range 25-81, p < 0.001). In the subgroup of patients with anticoagulant and/or antiplatelet therapy administered preoperatively, the intracerebral hemorrhage > 10 mm on postoperative CT scan was higher in the image-guided group (36.8%) than in the robot-assisted group (5%, p < 0.001). CONCLUSION In our bicentric comparative study, robot-assisted stereotactic and image-guided biopsies have two main differences (shorter time but more frequent postoperative hematoma for image-guided biopsies); however, both techniques are demonstrated to be safe and efficient.
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Affiliation(s)
- Arthur Leclerc
- Department of Neurosurgery, Caen University Hospital, Caen, France
- UNICAEN, ISTCT/CERVOxy Group, UMR6030, GIP CYCERON, Normandy University, Caen, France
| | - Louise Deboeuf
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
| | - Angela Elia
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Oumaima Aboubakr
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
| | - Martin Planet
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
| | - Aziz Bedioui
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
| | - Fréderick Rault
- Department of Neurosurgery, Caen University Hospital, Caen, France
| | - Maxime Faisant
- Department of Anatomopathology, Caen University Hospital, Caen, France
| | - Alexandre Roux
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Giorgia Antonia Simboli
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Alessandro Moiraghi
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Thomas Gaberel
- Department of Neurosurgery, Caen University Hospital, Caen, France
- UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, Normandie University, Cyceron, Caen, France
| | - Johan Pallud
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Evelyne Emery
- Department of Neurosurgery, Caen University Hospital, Caen, France
- UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, Normandie University, Cyceron, Caen, France
| | - Marc Zanello
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France.
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France.
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van Baarsen KM, Woodley DEA, Slot KM, Woerdeman PA, Han KS, Hoving EW. Robotic alignment system Cirq (Brainlab) for navigated brain tumor biopsies in children. Childs Nerv Syst 2024; 40:99-108. [PMID: 37436473 DOI: 10.1007/s00381-023-06060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION The Cirq robotic alignment system (Brainlab, Munich, Germany) is a manually adjustable electronic arm with a robotic alignment module on its distal end, enabling the neurosurgeon to automatically and accurately align surgical instruments to a preoperatively planned trajectory. In this study, we share our first experiences and results using Cirq for intracranial tumor biopsy in children. METHODS From May 2021 until October 2022, all consecutive patients that underwent a brain tumor biopsy using Cirq were included and compared to a historical cohort of patients biopsied with the non-robotic system Varioguide (Brainlab, Munich, Germany). Patient-related data, tumor-related data, and surgery-related data were collected. Registration accuracy was calculated for different patient-to-image registration methods. Pre- and postoperative images were fused, and entry error, target error, and angulation error were calculated. RESULTS Thirty-seven patients, aged 1-19 years, were included (14 with Cirq and 23 with Varioguide). An integrated histopathological and molecular diagnosis was acquired in all cases. Patient-to-image registration was significantly more accurate when based on bone screw fiducials combined with intraoperative CT, as compared to surface matching or skin fiducials. The target error (Euclidian distance) was 5.3 mm for Cirq as compared to 8.3 mm for Varioguide, but this was not statistically significant. Entry error and angulation error were also not significantly different between both groups. CONCLUSION Intracranial biopsy with the Cirq robotic system is feasible and safe, and its accuracy does not differ from the Varioguide system.
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Affiliation(s)
- Kirsten M van Baarsen
- Department of Neuro-Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
- Department of Pediatric Neurosurgery, Utrecht University Medical Center/Wilhelmina Children's Hospital, Utrecht, The Netherlands.
| | - Darwin E A Woodley
- Department of Neuro-Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatric Neurosurgery, Utrecht University Medical Center/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - K Mariam Slot
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Peter A Woerdeman
- Department of Neuro-Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatric Neurosurgery, Utrecht University Medical Center/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Kuo S Han
- Department of Neuro-Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatric Neurosurgery, Utrecht University Medical Center/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Eelco W Hoving
- Department of Neuro-Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatric Neurosurgery, Utrecht University Medical Center/Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Kreatsoulas DC, Vignolles-Jeong J, Ambreen Y, Damante M, Akhter A, Lonser RR, Elder JB. Surgical Characteristics of Intracranial Biopsy Using a Frameless Stereotactic Robotic Platform: A Single-Center Experience. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00966. [PMID: 37976149 DOI: 10.1227/ons.0000000000000999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cranial robotics are a burgeoning field of neurosurgery. To date, all cranial robotic systems described have been computerized, arm-based instruments that take up significant space in the operating room. The Medtronic Stealth Autoguide robot has a smaller operating room footprint and offers multiaxial, frame-based surgical targeting. The authors set out to define the surgical characteristics of a novel robotic platform for brain biopsy in a large patient cohort. METHODS Patients who underwent stereotactic biopsy using the Stealth Autoguide cranial robotic platform from July 2020 to March 2023 were included in this study. Clinical, surgical, and histological data were collected and analyzed. RESULTS Ninety-six consecutive patients (50 female, 46 male) were included. The mean age at biopsy was 53.7 ± 18.0 years. The mean target depth was 68.2 ± 15.3 mm. The biopsy diagnostic tissue acquisition rate was 100%. The mean time from incision to biopsy tissue acquisition was 15.4 ± 9.9 minutes. Target lesions were located throughout the brain: in the frontal lobe (n = 32, 33.3%), parietal lobe (n = 21, 21.9%), temporal lobe (n = 22, 22.9%), deep brain nuclei/thalamus (n = 13, 13.5%), cerebellum (n = 7, 7.3%), and brainstem (n = 1, 1.0%). Most cases were gliomas (n = 75, 78.2%). Patients were discharged home on postoperative day 0 or 1 in 62.5% of cases. A total of 7 patients developed postoperative complications (7.2%). CONCLUSION This cranial robotic platform can be used for efficient, safe, and accurate cranial biopsies that allow for reliable diagnosis of intracranial pathology in a minimally invasive setting.
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Affiliation(s)
- Daniel C Kreatsoulas
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Joshua Vignolles-Jeong
- The Ohio State University College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Yamenah Ambreen
- The Ohio State University College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Mark Damante
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Asad Akhter
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Russell R Lonser
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - J Bradley Elder
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
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Deboeuf L, Moiraghi A, Debacker C, Peeters SM, Simboli GA, Roux A, Dezamis E, Oppenheim C, Chretien F, Pallud J, Zanello M. Feasibility and Accuracy of Robot-Assisted, Stereotactic Biopsy Using 3-Dimensional Intraoperative Imaging and Frameless Registration Tool. Neurosurgery 2023; 92:803-811. [PMID: 36700740 DOI: 10.1227/neu.0000000000002294] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Robot-assisted stereotactic biopsy is evolving: 3-dimensional intraoperative imaging tools and new frameless registration systems are spreading. OBJECTIVE To investigate the accuracy and effectiveness of a new stereotactic biopsy procedure. METHODS Observational, retrospective analysis of consecutive robot-assisted stereotactic biopsies using the Neurolocate (Renishaw) frameless registration system and intraoperative O-Arm (Medtronic) performed at a single institution in adults (2019-2021) and comparison with a historical series from the same institution (2006-2016) not using the Neurolocate nor the O-Arm. RESULTS In 100 patients (55% men), 6.2 ± 2.5 (1-14) biopsy samples were obtained at 1.7 ± 0.7 (1-3) biopsy sites. An histomolecular diagnosis was obtained in 96% of cases. The mean duration of the procedure was 59.0 ± 22.3 min. The mean distance between the planned and the actual target was 0.7 ± 0.7 mm. On systematic postoperative computed tomography scans, a hemorrhage ≥10 mm was observed in 8 cases (8%) while pneumocephalus was distant from the biopsy site in 76%. A Karnofsky Performance Status score decrease ≥20 points postoperatively was observed in 4%. The average dose length product was 159.7 ± 63.4 mGy cm. Compared with the historical neurosurgical procedure, this new procedure had similar diagnostic yield (96 vs 98.7%; P = .111) and rate of postoperative disability (4.0 vs 4.2%, P = .914) but was shorter (57.8 ± 22.9 vs 77.8 ± 20.9 min; P < .001) despite older patients. CONCLUSION Robot-assisted stereotactic biopsy using the Neurolocate frameless registration system and intraoperative O-Arm is a safe and effective neurosurgical procedure. The accuracy of this robot-assisted surgery supports its effectiveness for daily use in stereotactic neurosurgery.
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Affiliation(s)
- Louise Deboeuf
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
| | - Alessandro Moiraghi
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Clément Debacker
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Sophie M Peeters
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Giorgia Antonia Simboli
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
| | - Alexandre Roux
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Edouard Dezamis
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
| | - Catherine Oppenheim
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
- Department of Neuroradiology, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Fabrice Chretien
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
- Department of Neuropathology, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Marc Zanello
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
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Almairac F, Leplus A, Mondot L, Fontaine D. A New Noninvasive Frameless Registration System for Stereotactic Cranial Biopsy: A Technical Note. Oper Neurosurg (Hagerstown) 2023; 24:64-67. [PMID: 36227183 DOI: 10.1227/ons.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/16/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Although frame-based stereotactic biopsy is still considered the gold standard for brain biopsies, frameless robot-assisted stereotactic systems are now able to provide an equal level of safety and accuracy. However, both systems suffer from a lack of efficiency of the operative workflow. OBJECTIVE To describe the technique of a new frameless and noninvasive registration tool Neurolocate (Renishaw). This tool, combined with an intraoperative cone-beam computed tomography imaging system like O-ARM (Medtronic), might facilitate the achievement and workflow of robot-assisted stereotactic intracranial biopsies. METHODS Neurolocate is a 3-dimensional fiducial tool fixed directly on the Neuromate (Renishaw) robot arm. It consists of 5 radio-opaque spherical fiducials, whose geometry is constant. This tool made it possible to carry out the coregistration then the biopsy in the same operating time, following a five-step procedure described here. We retrospectively extracted selected preliminary results from our initial experience. RESULTS Over 1 year, 23 consecutive adult patients were biopsied with Neurolocate in our center. The mean overall operative time, from patient's installation to skin closure, was 97 minutes ± 27 (SD). The entire procedure took place in a single location unit (operating room), which facilitated workflow and surgical planning. No invasive gesture was performed outside of the operating time. CONCLUSION Neurolocate is a new frameless and noninvasive registration tool that could improve workflow and flexibility for operating room management and surgical planning. It may also increase the comfort of patients undergoing robot-assisted intracranial stereotactic biopsies. The accuracy and safety profile should be addressed in specific studies.
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Affiliation(s)
- Fabien Almairac
- Neurosurgery Department, Hôpital Pasteur 2, CHU de Nice, Nice, France.,UR2CA PIN, Université Côte d'Azur, Nice, France
| | - Aurélie Leplus
- Neurosurgery Department, Hôpital Pasteur 2, CHU de Nice, Nice, France.,UR2CA PIN, Université Côte d'Azur, Nice, France
| | - Lydiane Mondot
- Neuroradiology Department, Hôpital Pasteur 2, CHU de Nice, Nice, France.,UR2CA URRIS, Université Côte d'Azur, Nice, France
| | - Denys Fontaine
- Neurosurgery Department, Hôpital Pasteur 2, CHU de Nice, Nice, France.,UR2CA PIN, Université Côte d'Azur, Nice, France
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9
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Dong FY, Zhan Q, Shao ZK, Gu Q, Gao XT, Zhou B, Li L, Ma YW, Wang XF, Liang YC. Clinical study on the treatment of primary trigeminal neuralgia by robot-assisted percutaneous balloon compression. Front Surg 2022; 9:1007818. [DOI: 10.3389/fsurg.2022.1007818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundC-arm-guided percutaneous puncture balloon compression alone has risk factors of puncture failure, complications, and poor prognosis. Robot-assisted PBC can effectively increase the one-time puncture success rate and improve the safety of the procedure. However, evidence on the superiority of robot-assisted PBC over C-arm-guided PBC alone remains relatively limited.MethodsRetrospective analysis The clinical data of 60 patients with trigeminal neuralgia aged 60 years or older in the Department of Neurosurgery of the Fourth Hospital of Harbin Medical University from January 2021 to October 2021. There were 29 males and 31 females, and the patients’ ages ranged from 60 to 79 years, with an average of 71.63 ± 5.12 years. Two groups were divided according to the surgical method, the C-arm guidance-only group (30 cases, n = 30) and the robot-assisted group (30 cases, n = 30). The success rate of first puncture, total operation time, number of “pear-shaped” balloons, number of C-arm x-ray scans, and immediate postoperative relief rate were recorded in both groups, and follow-up was performed to evaluate the postoperative results and complications. The overall evaluation of postoperative results and complications was performed.ResultsIntraoperative balloon compression was successfully completed in all 60 patients, and the first puncture success rate was higher in the robot-assisted group than in the simple C-arm group, with a significant difference between the two groups (P < 0.001). In terms of intraoperative balloon morphology, the number of “pear-shaped” balloons was higher in the PBC than in the C-arm-only PBC group, with a significant difference between the two groups (P < 0.005). The degree of immediate postoperative remission in the robotic group was 0 VAS score, which was not statistically significant in both groups (P > 0.05). By the final follow-up, the mean VAS score of the robot-assisted group was lower than that of the simple C-arm group, and both were statistically significant (P < 0.05); complications of masticatory muscle weakness or abnormal facial sensation occurred in both groups after surgery, but the number of cases in the robot-assisted group was less than that of the simple C-arm group.ConclusionRobot-assisted PBC is better than PBC with a C-arm x-ray machine in terms of first puncture success rate, number of intraoperative balloon “pear-shaped” cases, number of C-arm x-ray scans and short-term efficacy.
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10
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Grossen AA, Pelargos PE, Raskin JS, Desai VR. Commentary: Using the ROSA Robot for Lesion Resection: A Novel Adapter With Added Applications. Oper Neurosurg (Hagerstown) 2022; 23:e214-e215. [PMID: 35972122 DOI: 10.1227/ons.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Audrey A Grossen
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, Department of Neurosurgery, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Panayiotis E Pelargos
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, Department of Neurosurgery, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Jeffrey S Raskin
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA.,Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Virendra R Desai
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, Department of Neurosurgery, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
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11
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Pilot study of a new type of machine vision-assisted stereotactic neurosurgery for EVD placement. Acta Neurochir (Wien) 2022; 164:2385-2393. [PMID: 35788905 DOI: 10.1007/s00701-022-05287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The usage of machine vision technologies for image-based analysis and inspection is increasing. With the advent of the ability to process high-dimension data instantly, the possibilities of machine vision multiply exponentially. Robots now use this technology to assist in surgery. OBJECTIVE The aim of this study is to explore the efficacy of Surgical Navigation Robot NaoTrac (Brain Navi Biotechnology Co., Ltd.), which utilizes machine vision-inspired technology for patient registration and stereotactic external ventricular drainage (EVD) by the robotic arm. METHODS Preoperative and postoperative computed tomography (CT) scans were acquired for each case. The surgeons planned the targets and trajectories with the preoperative CT images. The postoperative CT images were utilized in the accuracy measurements. RESULTS All 14 cases had cerebrospinal fluid drained through the catheter. The NaoTrac placed the catheter into the frontal horn in one attempt in 13 cases and was able to drain CSF in 12 cases. Not a single case had any bleeding or intraoperative complications. The average time spent on the patient registration was 142.8 s. The mean target deviation was 1.68 mm, and the mean angular deviation was 1.99°, all within the accepted tolerance for minimal tissue damage. CONCLUSION The results of this report demonstrate that machine vision-inspired patient registration is feasible and fast. NaoTrac has demonstrated its accuracy and safety in performing frameless catheter placement in 13 clinical cases. Other stereotactic neurosurgical operations such as stereotactic biopsy, depth electrode placement, deep brain stimulation electrode positioning, and neuroendoscopy may also be benefited from the assistance of NaoTrac.
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12
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Zhao Z, Xiao J, Wang J, Meng X, Li C, Xin T, Li S. Individualized CT image-guided free-hand catheter technique: A new and reliable method for minimally invasive evacuation of basal ganglia hematoma. Front Neurosci 2022; 16:947282. [PMID: 36090281 PMCID: PMC9461711 DOI: 10.3389/fnins.2022.947282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo validate the clinical reliability of an individualized CT image-guided‘ free-hand catheter technique (CTGFC) for basal ganglia hematoma (BGH) evacuation.MethodsFrom January 2017 to December 2020, 58 cases of patients with BGH who underwent catheter evacuation were enrolled. The surgery was conducted using the CTGFC (n = 31) or stereotactic catheter technique (STC, n = 27). The authors evaluated the baseline characteristics, operation-related indicators, postoperative complications, hospitalization-related indicators, short-term and long-term functional outcomes, and mortality rate 1 year after surgery.ResultsAll patients underwent BGH evacuation under non-general anesthesia in the CTGFC group. The operative time (p < 0.01) and operation costs (p < 0.05) were significantly shorter in the CTGFC group than that in the STC group (p < 0.01). Comparable results were found in the catheter indwelling duration, residual hematoma volume, hematoma evacuation rate, incidence of postoperative complications, hospital ICU stay, and hospital costs between these two groups (p > 0.05). The duration of hospital stay was remarkably shorter in the CTGFC group than that in the STC group (p < 0.01). There were no differences in terms of the short-time functional outcomes score at discharge, including the Glasgow outcome scale (GOS) score, the activities of daily living (ADL) score, and the Karnofsky performance score (KPS). Moreover, comparable findings were also found in the 1-year postoperative GOS score, ADL score, KPS score, and mortality rate between these two groups.ConclusionThe simple CTGFC-assisted surgery was a safe and reliable option for BGH evacuation, especially in primary medical institutes and emergency situations with limited medical resources.
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Affiliation(s)
- Zhijie Zhao
- Department of Neurosurgery, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Neurosurgery, Jinan, China
| | - Jinting Xiao
- Department of Medical Ultrasound, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, Jinan, China
| | - Jianjun Wang
- Department of Neurosurgery, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Neurosurgery, Jinan, China
| | - Xiangjing Meng
- Department of Neurosurgery, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Neurosurgery, Jinan, China
| | - Cuiling Li
- Department of Neurosurgery, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Neurosurgery, Jinan, China
| | - Tao Xin
- Department of Neurosurgery, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Neurosurgery, Jinan, China
- Department of Neurosurgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
- *Correspondence: Tao Xin
| | - Shengjie Li
- Department of Neurosurgery, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Neurosurgery, Jinan, China
- Department of Neurosurgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
- Shengjie Li
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13
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Frameless robot-assisted stereotactic biopsy: an effective and minimally invasive technique for pediatric diffuse intrinsic pontine gliomas. J Neurooncol 2022; 160:107-114. [PMID: 35997920 DOI: 10.1007/s11060-022-04122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/19/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Diffuse intrinsic pontine gliomas (DIPGs) are prone to high surgical risks, and they could even lead to death due to their specific sites. To determine the value of frameless robot-assisted stereotactic biopsies of DIPGs, when compared it with microsurgical biopsies. METHODS We conducted a retrospective study of 71 pediatric patients who underwent biopsies from January 2016 to January 2021. (i) group 1: microsurgical biopsies, and (ii) group 2: frameless robot-assisted stereotactic biopsies. Demographic information, neuroimaging characteristics, pathological diagnoses, operation time, postoperative intensive care unit (ICU) stay time, postoperative hospitalization time, complications, cost, and perioperative mortality rate (POMR) were collected for analyses. RESULTS 32 Cases underwent microsurgical biopsies (group 1) and 39 cases underwent frameless robot-assisted stereotactic biopsies (group 2). All cases were accurately diagnosed after surgery. There was no significant difference in gender, age, symptom times and tumor volumes between the two groups (p > 0.05); operation time, postoperative ICU, stay time and postoperative hospitalization time were longer in group 1 than in group 2 (p < 0.001); the intraoperative bleeding volumes and cost were higher in group 1 than in group 2 (p < 0.001). Group 1 patients required more perioperative blood transfusion than group 2 (p = 0.001), and the new neurological impairments were more frequent in group 1 than in group 2 (p = 0.003). The POMR was 9.38% (3/32) in group 1 and 0 in group 2 (p = 0.087). CONCLUSIONS Frameless robot-assisted stereotactic biopsy was an effective and minimally invasive technique for pediatric DIPGs.
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Minchev G, Wurzer A, Ptacek W, Kronreif G, Micko A, Dorfer C, Wolfsberger S. Development of a miniaturized robotic guidance device for stereotactic neurosurgery. J Neurosurg 2022; 137:479-488. [PMID: 34920429 DOI: 10.3171/2021.9.jns21794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Consistently high accuracy and a straightforward use of stereotactic guidance systems are crucial for precise stereotactic targeting and a short procedural duration. Although robotic guidance systems are widely used, currently available systems do not fully meet the requirements for a stereotactic guidance system that combines the advantages of frameless surgery and robotic technology. The authors developed and optimized a small-scale yet highly accurate guidance system that can be seamlessly integrated into an existing operating room (OR) setup due to its design. The aim of this clinical study is to outline the development of this miniature robotic guidance system and present the authors' clinical experience. METHODS After extensive preclinical testing of the robotic stereotactic guidance system, adaptations were implemented for robot fixation, software usability, navigation integration, and end-effector application. Development of the robotic system was then advanced in a clinical series of 150 patients between 2013 and 2019, including 111 needle biopsies, 13 catheter placements, and 26 stereoelectroencephalography (SEEG) electrode placements. During the clinical trial, constant modifications were implemented to meet the setup requirements, technical specifications, and workflow for each indication. For each application, specific setup, workflow, and median procedural accuracy were evaluated. RESULTS Application of the miniature robotic system was feasible in 149 of 150 cases. The setup in each procedure was successfully implemented without adding significant OR time. The workflow was seamlessly integrated into the preexisting procedure. In the course of the study, procedural accuracy was improved. For the biopsy procedure, the real target error (RTE) was reduced from a mean of 1.8 ± 1.03 mm to 1.6 ± 0.82 mm at entry (p = 0.05), and from 1.7 ± 1.12 mm to 1.6 ± 0.72 mm at target (p = 0.04). For the SEEG procedures, the RTE was reduced from a mean of 1.43 ± 0.78 mm in the first half of the procedures to 1.12 ± 0.52 mm (p = 0.002) at entry in the second half, and from 1.82 ± 1.13 mm to 1.57 ± 0.98 mm (p = 0.069) at target, respectively. No healing complications or infections were observed in any case. CONCLUSIONS The miniature robotic guidance device was able to prove its versatility and seamless integration into preexisting workflow by successful application in 149 stereotactic procedures. According to these data, the robot could significantly improve accuracy without adding time expenditure.
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Affiliation(s)
- Georgi Minchev
- 1Department of Neurosurgery, Medical University Vienna; and
| | - Ayguel Wurzer
- 1Department of Neurosurgery, Medical University Vienna; and
| | - Wolfgang Ptacek
- 2Austrian Center for Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria
| | - Gernot Kronreif
- 2Austrian Center for Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria
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15
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Spyrantis A, Woebbecke T, Rueß D, Constantinescu A, Gierich A, Luyken K, Visser-Vandewalle V, Herrmann E, Gessler F, Czabanka M, Treuer H, Ruge M, Freiman TM. Accuracy of Robotic and Frame-Based Stereotactic Neurosurgery in a Phantom Model. Front Neurorobot 2022; 16:762317. [PMID: 35515711 PMCID: PMC9063629 DOI: 10.3389/fnbot.2022.762317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background The development of robotic systems has provided an alternative to frame-based stereotactic procedures. The aim of this experimental phantom study was to compare the mechanical accuracy of the Robotic Surgery Assistant (ROSA) and the Leksell stereotactic frame by reducing clinical and procedural factors to a minimum. Methods To precisely compare mechanical accuracy, a stereotactic system was chosen as reference for both methods. A thin layer CT scan with an acrylic phantom fixed to the frame and a localizer enabling the software to recognize the coordinate system was performed. For each of the five phantom targets, two different trajectories were planned, resulting in 10 trajectories. A series of five repetitions was performed, each time based on a new CT scan. Hence, 50 trajectories were analyzed for each method. X-rays of the final cannula position were fused with the planning data. The coordinates of the target point and the endpoint of the robot- or frame-guided probe were visually determined using the robotic software. The target point error (TPE) was calculated applying the Euclidian distance. The depth deviation along the trajectory and the lateral deviation were separately calculated. Results Robotics was significantly more accurate, with an arithmetic TPE mean of 0.53 mm (95% CI 0.41–0.55 mm) compared to 0.72 mm (95% CI 0.63–0.8 mm) in stereotaxy (p < 0.05). In robotics, the mean depth deviation along the trajectory was −0.22 mm (95% CI −0.25 to −0.14 mm). The mean lateral deviation was 0.43 mm (95% CI 0.32–0.49 mm). In frame-based stereotaxy, the mean depth deviation amounted to −0.20 mm (95% CI −0.26 to −0.14 mm), the mean lateral deviation to 0.65 mm (95% CI 0.55–0.74 mm). Conclusion Both the robotic and frame-based approach proved accurate. The robotic procedure showed significantly higher accuracy. For both methods, procedural factors occurring during surgery might have a more relevant impact on overall accuracy.
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Affiliation(s)
- Andrea Spyrantis
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- *Correspondence: Andrea Spyrantis
| | - Tirza Woebbecke
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Daniel Rueß
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anne Constantinescu
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Andreas Gierich
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Klaus Luyken
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University, Frankfurt am Main, Germany
| | - Florian Gessler
- Department of Neurosurgery, University Medical Center Rostock, Rostock, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Harald Treuer
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maximilian Ruge
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thomas M. Freiman
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- Department of Neurosurgery, University Medical Center Rostock, Rostock, Germany
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16
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Musa MJ, Carpenter AB, Kellner C, Sigounas D, Godage I, Sengupta S, Oluigbo C, Cleary K, Chen Y. Minimally Invasive Intracerebral Hemorrhage Evacuation: A review. Ann Biomed Eng 2022; 50:365-386. [PMID: 35226279 DOI: 10.1007/s10439-022-02934-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/11/2022] [Indexed: 11/01/2022]
Abstract
Intracerebral hemorrhage is a leading cause of morbidity and mortality worldwide. To date, there is no specific treatment that clearly provides a benefit in functional outcome or mortality. Surgical treatment for hematoma evacuation has not yet shown clear benefit over medical management despite promising preclinical studies. Minimally invasive treatment options for hematoma evacuation are under investigation but remain in early-stage clinical trials. Robotics has the potential to improve treatment. In this paper, we review intracerebral hemorrhage pathology, currently available treatments, and potential robotic approaches to date. We also discuss the future role of robotics in stroke treatment.
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Affiliation(s)
- Mishek J Musa
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, USA
| | | | - Christopher Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, NY, USA
| | - Dimitri Sigounas
- Department of Neurosurgery, The George Washington University, Washington, Washington, DC, USA
| | - Isuru Godage
- College of Computing and Digital Media, DePaul University, Chicago, IL, USA
| | - Saikat Sengupta
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chima Oluigbo
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Yue Chen
- Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Dr NW, Atlanta, GA, 30332, USA.
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17
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Narsinh KH, Paez R, Mueller K, Caton MT, Baker A, Higashida RT, Halbach VV, Dowd CF, Amans MR, Hetts SW, Norbash AM, Cooke DL. Robotics for neuroendovascular intervention: Background and primer. Neuroradiol J 2022; 35:25-35. [PMID: 34398721 PMCID: PMC8826289 DOI: 10.1177/19714009211034829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The simultaneous growth of robotic-assisted surgery and telemedicine in recent years has only been accelerated by the recent coronavirus disease 2019 pandemic. Robotic assistance for neurovascular intervention has garnered significant interest due to opportunities for tele-stroke models of care for remote underserved areas. Lessons learned from medical robots in interventional cardiology and neurosurgery have contributed to incremental but vital advances in medical robotics despite important limitations. In this article, we discuss robot types and their clinical justification and ethics, as well as a general overview on available robots in thoracic/abdominal surgery, neurosurgery, and cardiac electrophysiology. We conclude with current clinical research in neuroendovascular intervention and a perspective on future directions.
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Affiliation(s)
- Kazim H Narsinh
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA,Kazim H Narsinh and Daniel L Cooke, UCSF
Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, L-309, San
Francisco, CA 94117, USA. ;
| | - Ricardo Paez
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | | | - M Travis Caton
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | - Amanda Baker
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | - Randall T Higashida
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | - Van V Halbach
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | - Christopher F Dowd
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | - Matthew R Amans
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | - Steven W Hetts
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | | | - Daniel L Cooke
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA,Kazim H Narsinh and Daniel L Cooke, UCSF
Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, L-309, San
Francisco, CA 94117, USA. ;
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18
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Machetanz K, Grimm F, Wang S, Schuhmann MU, Tatagiba M, Gharabaghi A, Naros G. Rediscovery of the transcerebellar approach: improving the risk-benefit ratio in robot-assisted brainstem biopsies. Neurosurg Focus 2022; 52:E12. [DOI: 10.3171/2021.10.focus21359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Conventional frame-based stereotaxy through a transfrontal approach (TFA) is the gold standard in brainstem biopsies. Because of the high surgical morbidity and limited impact on therapy, brainstem biopsies are controversial. The introduction of robot-assisted stereotaxy potentially improves the risk-benefit ratio by simplifying a transcerebellar approach (TCA). The aim of this single-center cohort study was to evaluate the risk-benefit ratio of transcerebellar brainstem biopsies performed by 2 different robotic systems. In addition to standard quality indicators, a special focus was set on trajectory selection for reducing surgical morbidity.
METHODS
This study included 25 pediatric (n = 7) and adult (n = 18) patients who underwent 26 robot-assisted biopsies via a TCA. The diagnostic yield, complication rate, trajectory characteristics (i.e., length, anatomical entry, and target-point location), and skin-to-skin (STS) time were evaluated. Transcerebellar and hypothetical transfrontal trajectories were reconstructed and transferred into a common MR space for further comparison with anatomical atlases.
RESULTS
Robot-assisted, transcerebellar biopsies demonstrated a high diagnostic yield (96.2%) while exerting no surgical mortality and no permanent morbidity in both pediatric and adult patients. Only 3.8% of cases involved a transient neurological deterioration. Transcerebellar trajectories had a length of 48.4 ± 7.3 mm using a wide stereotactic corridor via crus I or II of the cerebellum and the middle cerebellar peduncle. The mean STS time was 49.5 ± 23.7 minutes and differed significantly between the robotic systems (p = 0.017). The TFA was characterized by longer trajectories (107.4 ± 11.8 mm, p < 0.001) and affected multiple eloquent structures. Transfrontal target points were located significantly more medial (−3.4 ± 7.2 mm, p = 0.042) and anterior (−3.9 ± 8.4 mm, p = 0.048) in comparison with the transcerebellar trajectories.
CONCLUSIONS
Robot-assisted, transcerebellar stereotaxy can improve the risk-benefit ratio of brainstem biopsies by avoiding the restrictions of a TFA and conventional frame-based stereotaxy. Profound registration and anatomical-functional trajectory selection were essential to reduce mortality and morbidity.
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Affiliation(s)
- Kathrin Machetanz
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Florian Grimm
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Sophie Wang
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen
| | - Martin U. Schuhmann
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen
| | - Marcos Tatagiba
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen
| | - Alireza Gharabaghi
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Georgios Naros
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
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Mallereau CH, Chibbaro S, Ganau M, Benmekhbi M, Cebula H, Dannhoff G, Santin MDN, Ollivier I, Chaussemy D, Hugo Coca A, Proust F, Todeschi J. Pushing the boundaries of accuracy and reliability during stereotactic procedures: A prospective study on 526 biopsies comparing the frameless robotic and Image-Guided Surgery systems. J Clin Neurosci 2021; 95:203-212. [PMID: 34933231 DOI: 10.1016/j.jocn.2021.11.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 11/10/2021] [Accepted: 11/27/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION A 12-year long, prospective, single center study was conducted, comparing two frameless systems for brain biopsies: ROSA robotic-assisted stereotaxy and BrainLab Varioguide image-guided stereotaxy (Image Guided Surgery, IGS). METHOD All consecutive adult and pediatric patients undergoing frameless brain biopsies were included. Successfully achieving diagnosis was the primary endpoint, analysis of all periprocedural complications was the secondary endpoint, and the tertiary endpoint was the length of the procedure, with the aim of assessing of the learning curve for each operator over time. The results for the ROSA robot and the Varioguide system were compared and benchmarked to data from the literature. RESULTS We performed 526 on 516 patients, 314 with the ROSA robot (Group A) and 212 with the IGS Varioguide (Group B). Histological diagnosis was achieved in 97.4% of cases in Group A, versus 93.3% in Group B (p < 0.05). No statistically significant difference was found for secondary and tertiary endpoints. The complication rate appeared similar between the 2 frameless systems, with a hemorrhagic complications rate of 3.5% in Group A and 4.7% in Group B. Permanent neurological deterioration was only recorded in 0.8% of cases from Group B. Mortality was recorded in 0.3% in Group A and 0.4% in Group B. CONCLUSION This study provides evidence to confirm that robotic surgery lives up to its promises of increased safety, accuracy, and reliability.
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Affiliation(s)
| | - Salvatore Chibbaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Mario Ganau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Mustapha Benmekhbi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Helene Cebula
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Guillaume Dannhoff
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | | | - Irène Ollivier
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Dominique Chaussemy
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Andres Hugo Coca
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - François Proust
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Julien Todeschi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
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20
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Enders F, Rothfuss A, Brehmer S, Stallkamp J, Schulte DM, Hänggi D. Optimized Intraoperative Imaging for Stereotactic Planning with a Multiaxial Robotic C-arm System: Technical Note and Case Series. J Neurol Surg A Cent Eur Neurosurg 2021; 83:588-595. [PMID: 34781408 DOI: 10.1055/s-0041-1731754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The preoperative preparation of the planning dataset for frame-based stereotactic brain biopsy is often associated with logistical effort and burden on the patient. Intraoperative imaging modalities need to be investigated to overcome these limitations. OBJECTIVE The objective of the study was to develop and apply a new method for the intraoperative acquisition of the planning dataset with the multiaxial robotic C-arm system Artis zeego. METHODS An indication-customized dose-reduced protocol for Artis zeego was developed and implemented into the workflow. A sample of 14 patients who had undergone intraoperative imaging with Artis zeego was analyzed. A sample of 10 patients with conventional preoperative imaging by cranial computed tomography (CT) was used as a control group. Outcomes were compared with regard to target deviation, diagnostic value of the biopsies, complications, and procedure time. RESULTS In all patients, a suitable intraoperative planning dataset could be acquired with Artis zeego. Total procedure time was shorter for the Artis zeego group (p = 0.01), whereas time in the operating room area was longer in the Artis zeego group (p = 0.04). Biopsy results were diagnostic in 12 patients (86%) in the Artis zeego group and in 8 patients (80%) in the control group. There were no significant differences in target size, trajectory length, or target deviation. CONCLUSION Intraoperative imaging for frame-based stereotactic brain biopsy with Artis zeego is an easy and feasible method. Accuracy is comparable to conventional CT, whereas radiation exposure could be additionally reduced. It allows a significant reduction of the total procedure length and improves the comfort for the patient and staff.
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Affiliation(s)
- Frederik Enders
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Andreas Rothfuss
- Fraunhofer IPA Mannheim - Fraunhofer-Projektgruppe für Automatisierung in der Medizin und Biotechnologie PAMB, Mannheim, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Jan Stallkamp
- Fraunhofer IPA Mannheim - Fraunhofer-Projektgruppe für Automatisierung in der Medizin und Biotechnologie PAMB, Mannheim, Germany
| | | | - Daniel Hänggi
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany.,Department of Neurosurgery, University Hospital Dusseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
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21
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22
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Reassessing the Role of Brain Tumor Biopsy in the Era of Advanced Surgical, Molecular, and Imaging Techniques-A Single-Center Experience with Long-Term Follow-Up. J Pers Med 2021; 11:jpm11090909. [PMID: 34575685 PMCID: PMC8472374 DOI: 10.3390/jpm11090909] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 01/11/2023] Open
Abstract
Brain biopsy is the gold standard in order to establish the diagnosis of unresectable brain tumors. Few studies have investigated the long-term outcomes of biopsy patients. The aim of this single-institution-based study was to assess the concordance between radiological and histopathological diagnoses, and the long-term patient outcome. Ninety-three patients who underwent brain biopsy in the last 5 years were analyzed. We included patients treated with stereotactically guided needle, open, and neuroendoscopic biopsies. Most patients (86%) received needle biopsy. Gliomas and primary brain lymphomas comprised 88.2% of cases. The diagnostic yield was 95.7%. Serious complication and death rates were 3.2% and 2.1%, respectively. The concordance rate between radiological and histological diagnoses was 93%. Notably, the positive predictive value of radiological diagnosis of lymphoma was 100%. Biopsy allowed specific treatment in 72% of cases. Disease-related neurological worsening was the main reason that precluded adjuvant treatment. Adjuvant treatment, in turn, was the strongest prognostic factor, since the median overall survival was 11 months with vs. 2 months without treatment (p = 0.0002). Finally, advanced molecular evaluations can be obtained on glioma biopsy specimens to provide integrated diagnoses and individually tailored treatments. We conclude that, despite the huge advances in imaging techniques, biopsy is required when an adjuvant treatment is recommended, particularly in gliomas.
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23
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Fogg DN, Mallela AN, Abou-Al-Shaar H, González-Martínez J. Robotic-assisted stereotactic drainage of cerebral abscess and placement of ventriculostomy. Br J Neurosurg 2021:1-4. [PMID: 34463595 DOI: 10.1080/02688697.2021.1969006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Robotic surgery has found increasing use in multiple subfields of neurosurgery. While the initial applications of stereotactic robotic surgery were for the placement of electrodes for extra-operative seizure monitoring, this technique has become increasingly relevant in other areas of neurosurgery. To the best of our knowledge, we report the first case of successful robotic surgery utilization to drain a cerebral abscess and place an external ventricular drain. CASE REPORT The authors demonstrate a novel use for stereotactic robotic assistance to drain a cerebral abscess and place ventriculostomy in a 74-year-old female patient who presented with a left basal ganglia Streptococcus intermedius abscess and concomitant ventriculitis. Drainage of a deep-seated abscess and placement of ventriculostomy was successfully performed in this patient without intraoperative difficulties or complications. The total operative time, including registration was 64 minutes and the estimated blood loss was 25 mL. The patient recovered well and was discharged to inpatient rehabilitation on postoperative day 19. CONCLUSIONS The use of robotic surgery to drain cerebral abscesses and place ventriculostomies is technically feasible and may potentially decrease operative time and increase accuracy and safety.
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Affiliation(s)
- David N Fogg
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arka N Mallela
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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24
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Li L, Yang S, Peng W, Ding H, Wang G. A CT Image-Based Virtual Sensing Method to Estimate Bone Drilling Force for Surgery Robots. IEEE Trans Biomed Eng 2021; 69:871-881. [PMID: 34460361 DOI: 10.1109/tbme.2021.3108400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective: Understanding medical images like the human surgeon is a challenge for current surgical robots. It is still hard for surgical robots to achieve safe and stable operations with the help of priori information from preoperative images. We proposed a method to estimate drilling force information based on preoperative images, which can provide priori force information for surgical robots to perform bone drilling tasks. METHODS A visual sensing computing framework is proposed to obtain the 3D image information from the drill-tissue contact area in a one-dimensional signal format. Under this computing framework, a computed tomography (CT) image-weighted bone drilling mechanical model is built. The model considers both targets bone shape and material properties to predict the thrust force, torque, and radial force of a drilling process based on preoperative CT images. RESULTS The built model can respond to multiple bone drilling process factors, such as personalized surgery plans, varying tissue densities, uneven drilling surfaces, different drilling speeds, feed rates, and drill bit geometries. The minimum error of the predicted thrust force on bovine bones is 1.130.95 N, and the best normalized average prediction error on porcine bones is 0.070.08. Experiments in spinal pedicle screw placement surgery also show potential application abilities. CONCLUSION Our method predicts the bone drilling force well based on preoperative images, providing robots with more efficient preoperative information. SIGNIFICANCE This work offers a new perspective to study the interaction relationship between robot surgical instruments and tissues with the assistance of preoperative images.
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25
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Liu HG, Liu YY, Zhang H, Meng FG, Zhang K, Zhu GY, Chen YC, Liu DF, Zhang JG, Yang AC. A Bulk Retrospective Study of Robot-Assisted Stereotactic Biopsies of Intracranial Lesions Guided by Videometric Tracker. Front Neurol 2021; 12:682733. [PMID: 34421791 PMCID: PMC8371178 DOI: 10.3389/fneur.2021.682733] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Biopsies play an important role in the diagnosis of intracranial lesions, and robot-assisted procedures are increasingly common in neurosurgery centers. This research investigates the diagnoses, complications, and technology yield of 700 robotic frameless intracranial stereotactic biopsies conducted with the Remebot system. Method: This research considered 700 robotic biopsies performed between 2016 and 2020 by surgeons from the Department of Functional Neurosurgery in Beijing's Tiantan Hospital. The data collected included histological diagnoses, postoperative complications, operation times, and the accuracy of robotic manipulation. Results: Among the 700 surgeries, the positive rate of the biopsies was 98.2%. The most common histological diagnoses were gliomas, which accounted for 62.7% of cases (439/700), followed by lymphoma and germinoma, which accounted for 18.7% (131/700) and 7.6% (53/700). Bleeding was found in 14 patients (2%) by post-operation computed tomography scans. A total of 29 (4.14%) patients had clinical impairments after the operation, and 9 (1.29%) experienced epilepsy during the operation. The post-biopsy mortality rate was 0.43%. Operation time-from marking the cranial point to suturing the skin-was 16.78 ± 3.31 min (range 12-26 min). The target error was 1.13 ± 0.30 mm, and the entry point error was 0.99 ± 0.24 mm. Conclusion: A robot-assisted frameless intracranial stereotactic biopsy guided by a videometric tracker is an efficient, safe, and accurate method for biopsies.
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Affiliation(s)
- Huan-Guang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu-Ye Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hua Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fan-Gang Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guan-Yu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying-Chuan Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - De-Feng Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Beijing, China
| | - An-Chao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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26
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Rubino F, Eichberg DG, Cordeiro JG, Di L, Eliahu K, Shah AH, Luther EM, Lu VM, Komotar RJ, Ivan ME. Robotic guidance platform for laser interstitial thermal ablation and stereotactic needle biopsies: a single center experience. J Robot Surg 2021; 16:549-557. [PMID: 34258748 PMCID: PMC8276839 DOI: 10.1007/s11701-021-01278-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/04/2021] [Indexed: 11/28/2022]
Abstract
While laser ablation has become an increasingly important tool in the neurosurgical oncologist's armamentarium, deep seated lesions, and those located near critical structures require utmost accuracy during stereotactic laser catheter placement. Robotic devices have evolved significantly over the past two decades becoming an accurate and safe tool for stereotactic neurosurgery. Here, we present our single center experience with the MedTech ROSA ONE Brain robot for robotic guidance in laser interstitial thermal therapy (LITT) and stereotactic biopsies. We retrospectively analyzed the first 70 consecutive patients treated with ROSA device at a single academic medical center. Forty-three patients received needle biopsy immediately followed by LITT with the catheter placed with robotic guidance and 27 received stereotactic needle biopsy alone. All the procedures were performed frameless with skull bone fiducials for registration. We report data regarding intraoperative details, mortality and morbidity, diagnostic yield and lesion characteristics on MRI. Also, we describe the surgical workflow for both procedures. The mean age was 60.3 ± 15 years. The diagnostic yield was positive in 98.5% (n = 69). Sixty-three biopsies (90%) were supratentorial and seven (10%) were infratentorial. Gliomas represented 54.3% of the patients (n = 38). There were two postoperative deaths (2.8%). No permanent morbidity related to surgery were observed. We did not find intraoperative technical problems with the device. There was no need to reposition the needle after the initial placement. Stereotactic robotic guided placement of laser ablation catheters and biopsy needles is safe, accurate, and can be implemented into a neurosurgical workflow.
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Affiliation(s)
- Franco Rubino
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA.
| | - Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA
| | - Joacir G Cordeiro
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA
| | - Long Di
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA
| | - Karen Eliahu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA
| | - Evan M Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA.,Sylvester Comprehensive Cancer Center, Miami, FL, 33146, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA.,Sylvester Comprehensive Cancer Center, Miami, FL, 33146, USA
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27
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Bonda DJ, Pruitt R, Theroux L, Goldstein T, Stefanov DG, Kothare S, Karkare S, Rodgers S. Robot-assisted stereoelectroencephalography electrode placement in twenty-three pediatric patients: a high-resolution analysis of individual lead placement time and accuracy at a single institution. Childs Nerv Syst 2021; 37:2251-2259. [PMID: 33738542 DOI: 10.1007/s00381-021-05107-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We describe a detailed evaluation of predictors associated with individual lead placement efficiency and accuracy for 261 stereoelectroencephalography (sEEG) electrodes placed for epilepsy monitoring in twenty-three children at our institution. METHODS Intra- and post-operative data was used to generate a linear mixed model to investigate predictors associated with three outcomes (lead placement time, lead entry error, lead target error) while accounting for correlated observations from the same patients. Lead placement time was measured using electronic time-stamp records stored by the ROSA software for each individual electrode; entry and target site accuracy was measured using postoperative stereotactic CT images fused with preoperative electrode trajectory planning images on the ROSA computer software. Predictors were selected from a list of variables that included patient demographics, laterality of leads, anatomic location of lead, skull thickness, bolt cap device used, and lead sequence number. RESULTS Twenty-three patients (11 female, 48%) of mean age 11.7 (± 6.1) years underwent placement of intracranial sEEG electrodes (median 11 electrodes) at our institution over a period of 1 year. There were no associated infections, hemorrhages, or other adverse events, and successful seizure capture was obtained in all monitored patients. The mean placement time for individual electrodes across all patients was 6.56 (± 3.5) min; mean target accuracy was 4.5 (± 3.5) mm. Lesional electrodes were associated with 25.7% (95% CI: 6.7-40.9%, p = 0.02) smaller target point errors. Larger skull thickness was associated with larger error: for every 1-mm increase in skull thickness, there was a 4.3% (95% CI: 1.2-7.5%, p = 0.007) increase in target error. Bilateral lead placement was associated with 26.0% (95% CI: 9.9-44.5%, p = 0.002) longer lead placement time. The relationship between placement time and lead sequence number was nonlinear: it decreased consistently for the first 4 electrodes, and became less pronounced thereafter. CONCLUSIONS Variation in sEEG electrode placement efficiency and accuracy can be explained by phenomena both within and outside of operator control. It is important to keep in mind the factors that can lead to better or worse lead placement efficiency and/or accuracy in order to maximize patient safety while maintaining the standard of care.
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Affiliation(s)
- David J Bonda
- Division of Pediatric Neurosurgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY, USA
| | - Rachel Pruitt
- Division of Pediatric Neurosurgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY, USA
| | - Liana Theroux
- Division of Pediatric Neurology, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY, USA
| | - Todd Goldstein
- Center for 3D Design and Innovation, Northwell Health, Manhasset, NY, USA
| | - Dimitre G Stefanov
- Department of Biostatistics, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Sanjeev Kothare
- Division of Pediatric Neurology, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY, USA
| | - Shefali Karkare
- Division of Pediatric Neurology, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY, USA
| | - Shaun Rodgers
- Division of Pediatric Neurosurgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY, USA.
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Comparison of frame-less robotic versus frame-based stereotactic biopsy of intracranial lesions. Clin Neurol Neurosurg 2021; 207:106762. [PMID: 34153776 DOI: 10.1016/j.clineuro.2021.106762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Robotic guidance might be an alternative to classic stereotaxy for biopsies of intracranial lesions. Both methods were compared regarding time efficacy, histopathological results and complications. METHODS A retrospective analysis enrolling all patients undergoing robotic- or stereotactic biopsies between 01/2015 and 12/2018 was conducted. Trajectory planning was performed on magnetic resonance imaging (MRI). With the Robotic Surgery Assistant (ROSA), patient registration was accomplished using a facial laser scan in the operating room (OR), immediately followed by biopsy. In stereotaxy, patients were transported to the CT for Leksell Frame registration, followed by biopsy in the OR. RESULTS The average overall procedure time amounted in robotics to 169 min and in stereotaxy to 179 min (p = 0.005). The difference was greatest for temporal targets, amounting in robotics to 161 min and in stereotaxy to 188 min (p = 0,0007). However, the average time spent purely in the OR amounted in robotics to 140 min and in stereotaxy to 113 min (p < 0.001). In 150 robotic biopsies, diagnostic yield amounted to 98%, in 266 stereotactic biopsies to 91%. Symptomatic postoperative hemorrhages were observed in 3 patients (2%) in robotic biopsy and 7 patients (2,7%) in stereotactic biopsy. CONCLUSION Robotics showed a shorter overall procedure time as there is no need for a transport to the CT whereas the pure OR time was shorter in stereotaxy due to skipping the laser registration process. Diagnostic yield was higher in robotics, most likely due to case selection, complication rates were equal.
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29
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Machetanz K, Grimm F, Wang S, Bender B, Tatagiba M, Gharabaghi A, Naros G. Patient-to-robot registration: The fate of robot-assisted stereotaxy. Int J Med Robot 2021; 17:e2288. [PMID: 34036749 DOI: 10.1002/rcs.2288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/22/2021] [Accepted: 05/22/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Robot-assisted stereotaxy (RAS) promises higher stereotactic accuracy (SA) and time efficiency (TE) than frame-based stereotaxy. However, both aspects are attributed to the problem of patient-to-robot registration. OBJECTIVE To examine different registration techniques regarding their SA and TE. METHODS This study enrolled 57 patients undergoing RAS with bone fiducial registration (BFR) or laser surface registration (LSR). SA was measured by the entry point error (EPE). Additionally, predictors of SA (registration error [RegE], distance-to-registration plane [DTC]) and TE (imaging, skin-to-skin) were assessed. RESULTS The mean SA was 1.0 ± 0.8 mm. BFR increased SA by reducing RegE and DTC. In LSR, EPE depended on DTC (face and forehead) with highest accuracy for DTC ≤100 mm. CT-based LSR exerted a higher SA than MR-based LSR. In BFR, TE was confined by the additional imaging. CONCLUSION Every registration technique counteracts one of the promises of RAS. New solutions are needed to increase the acceptance of RAS in neurosurgery.
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Affiliation(s)
- Kathrin Machetanz
- Department of Neurosurgery and Neurotechnology, Neurosurgical Clinic, Eberhard Karls University, Tuebingen, Germany.,Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Florian Grimm
- Department of Neurosurgery and Neurotechnology, Neurosurgical Clinic, Eberhard Karls University, Tuebingen, Germany.,Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Sophie Wang
- Department of Neurosurgery and Neurotechnology, Neurosurgical Clinic, Eberhard Karls University, Tuebingen, Germany
| | - Benjamin Bender
- Department of Neuroradiology, Eberhard Karls University, Tuebingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery and Neurotechnology, Neurosurgical Clinic, Eberhard Karls University, Tuebingen, Germany
| | - Alireza Gharabaghi
- Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Georgios Naros
- Department of Neurosurgery and Neurotechnology, Neurosurgical Clinic, Eberhard Karls University, Tuebingen, Germany.,Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
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30
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Naros G, Machetanz K, Grimm F, Roser F, Gharabaghi A, Tatagiba M. Framed and non-framed robotics in neurosurgery: A 10-year single-center experience. Int J Med Robot 2021; 17:e2282. [PMID: 34030218 DOI: 10.1002/rcs.2282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/15/2021] [Accepted: 05/11/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Safety, efficacy and efficiency of neurosurgical robots are defined by their design (i.e., framed and non-framed) and procedural workflow (PW) (from image to surgery). The present study describes the quality indicators of three different robots in brain and spine surgery. METHODS This single-centre study enrolled 252 patients over a 10-year period. Safety (complication rate) and efficacy (diagnostic yield, pedicle screw placement) were determined. Predictors of workflow efficiency (e.g., skin-to-skin) were evaluated and compared to conventional techniques (neuronavigation, stereotaxy). RESULTS All robots showed excellent reliability (97.5%-100%) with low complication rates (4.5%-5.3%) and high efficacy (94.7%-97.7%). Robotics demonstrated a better time-efficiency than neuronavigation. However, there was no shortening of surgery time compared to conventional stereotaxy. Time-efficiency differed significantly between framed and non-framed workflows. CONCLUSION While all neurosurgical robots were reliable, safe and efficacious, there were significant differences in time-efficiency. PWs should be improved to increase the acceptance of robotics in neurosurgery.
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Affiliation(s)
- Georgios Naros
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany.,Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, Eberhard Karls University Tuebingen, Germany
| | - Kathrin Machetanz
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany.,Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, Eberhard Karls University Tuebingen, Germany
| | - Florian Grimm
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany.,Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, Eberhard Karls University Tuebingen, Germany
| | - Florian Roser
- Department of Neurosurgery, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Alireza Gharabaghi
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany.,Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, Eberhard Karls University Tuebingen, Germany
| | - Marcos Tatagiba
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
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Schieferdecker S, Hunsche S, El Majdoub F, Maarouf M. Robot-Assisted Stereotactic Shunting as a Novel Treatment for Pontine Glioependymal Cysts. J Neurol Surg A Cent Eur Neurosurg 2021; 83:85-88. [PMID: 34030189 DOI: 10.1055/s-0041-1726109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this case report, the authors describe the first case of a glioependymal cyst of the brainstem managed by robot-assisted, stereotactic, cysto-ventricular shunting. Glioependymal cysts are rare congenital cystic lesions that are thought to form by displacement of ependymal cells during the embryonal period. Glioependymal cysts have been reported in a variety of different locations within the central nervous system. However, glioependymal cysts of the brainstem have only been described once before. Here, we report the case of a 53-year-old man who was referred to our department due to hemiparesis, hemihypesthesia, and hemidysesthesia, as well as facial and abducens nerve palsy. A large pontine glioependymal cyst was confirmed via magnetic resonance imaging (MRI) scans. The cyst was subsequently decompressed by connecting the cyst with the fourth ventricle via robot-assisted stereotactic shunt placement. In the postoperative course, the patient made a quick recovery and did not report any permanent neurologic deficits.
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Affiliation(s)
- Simon Schieferdecker
- Department of Medicine, Heinrich Heine University Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Stefan Hunsche
- Department of Stereotactic and Functional Neurosurgery, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - Faycal El Majdoub
- Department of Stereotactic and Functional Neurosurgery, Cologne Merheim Medical Center (CMMC), Cologne, Germany
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32
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Philipp LR, Matias CM, Thalheimer S, Mehta SH, Sharan A, Wu C. Robot-Assisted Stereotaxy Reduces Target Error: A Meta-Analysis and Meta-Regression of 6056 Trajectories. Neurosurgery 2021; 88:222-233. [PMID: 33045739 DOI: 10.1093/neuros/nyaa428] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 07/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The pursuit of improved accuracy for localization and electrode implantation in deep brain stimulation (DBS) and stereoelectroencephalography (sEEG) has fostered an abundance of disparate surgical/stereotactic practices. Specific practices/technologies directly modify implantation accuracy; however, no study has described their respective influence in multivariable context. OBJECTIVE To synthesize the known literature to statistically quantify factors affecting implantation accuracy. METHODS A systematic review and meta-analysis was conducted to determine the inverse-variance weighted pooled mean target error (MTE) of implanted electrodes among patients undergoing DBS or sEEG. MTE was defined as Euclidean distance between planned and final electrode tip. Meta-regression identified moderators of MTE in a multivariable-adjusted model. RESULTS A total of 37 eligible studies were identified from a search return of 2,901 potential articles (2002-2018) - 27 DBS and 10 sEEG. Random-effects pooled MTE = 1.91 mm (95% CI: 1.7-2.1) for DBS and 2.34 mm (95% CI: 2.1-2.6) for sEEG. Meta-regression identified study year, robot use, frame/frameless technique, and intraoperative electrophysiologic testing (iEPT) as significant multivariable-adjusted moderators of MTE (P < .0001, R2 = 0.63). Study year was associated with a 0.92-mm MTE reduction over the 16-yr study period (P = .0035), and robot use with a 0.79-mm decrease (P = .0019). Frameless technique was associated with a mean 0.50-mm (95% CI: 0.17-0.84) increase, and iEPT use with a 0.45-mm (95% CI: 0.10-0.80) increase in MTE. Registration method, imaging type, intraoperative imaging, target, and demographics were not significantly associated with MTE on multivariable analysis. CONCLUSION Robot assistance for stereotactic electrode implantation is independently associated with improved accuracy and reduced target error. This remains true regardless of other procedural factors, including frame-based vs frameless technique.
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Affiliation(s)
- Lucas R Philipp
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Caio M Matias
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Sara Thalheimer
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Shyle H Mehta
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Ashwini Sharan
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Chengyuan Wu
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
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33
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Kesserwan MA, Shakil H, Lannon M, McGinn R, Banfield L, Nath S, Alotaibi M, Kasper E, Sharma S. Frame-based versus frameless stereotactic brain biopsies: A systematic review and meta-analysis. Surg Neurol Int 2021; 12:52. [PMID: 33654555 PMCID: PMC7911151 DOI: 10.25259/sni_824_2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Stereotactic brain biopsy techniques have been a focus of rapid technological innovation. The recent advent of frameless stereotaxy has invited the question of whether it can provide the same diagnostic yield as frame-based techniques, without increasing risk of harm to patients. The goal of this meta-analysis was to compare each of these techniques in terms of yield and safety. Methods: We independently searched four databases for English studies comparing frameless and frame-based stereotactic brain biopsies. Our primary outcome was biopsy diagnostic yield. Our secondary outcomes included mortality, morbidity (e.g., symptomatic postbiopsy intracranial hemorrhage, asymptomatic postbiopsy intracranial hemorrhage, new postbiopsy neurological deficit, and postbiopsy seizure), and frequency of repeat biopsy. We calculated pooled estimates and relative risks for dichotomous outcomes using Review Manager 5.3, with corresponding 95% confidence intervals. Results: A total of 3256 stereotactic brain biopsies (2050 frame based and 1206 frameless), from 20 studies, were included in our final analysis. The results did not demonstrate any significant difference between the two stereotactic systems in terms of diagnostic yield (risk ratio [RR] 1.00, 95% confidence interval [CI] 0.99–1.02, P = 0.64, I2 = 0%). The only significant difference was the increased frequency of asymptomatic hemorrhages in the frameless group (RR 1.37, 95% CI 1.06–1.75, P = 0.01, I2 = 0%). Application of Grading of Recommendations Assessment, Development, and Evaluation to the results yielded very low quality of all outcomes. Conclusion: Based on very low-quality evidence, both frame-based and frameless stereotaxy are safe and effective for biopsy of intracranial tumors. Further study of patient preference and cost comparing analysis is required to identify if either modality should be preferred.
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Affiliation(s)
| | - Husain Shakil
- Department of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Lannon
- Department of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Ryan McGinn
- Department of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Laura Banfield
- Department of Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Siddharth Nath
- Department of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Mazen Alotaibi
- Department of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Ekkehard Kasper
- Department of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Sunjay Sharma
- Department of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
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Dlaka D, Švaco M, Chudy D, Jerbić B, Šekoranja B, Šuligoj F, Vidaković J, Romić D, Raguž M. Frameless stereotactic brain biopsy: A prospective study on robot-assisted brain biopsies performed on 32 patients by using the RONNA G4 system. Int J Med Robot 2021; 17:e2245. [PMID: 33591608 DOI: 10.1002/rcs.2245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND We present a novel robotic neuronavigation system (RONNA G4), used for precise preoperative planning and frameless neuronavigation, developed by a research group from the University of Zagreb and neurosurgeons from the University Hospital Dubrava, Zagreb, Croatia. The aim of study is to provide comprehensive error measurement analysis of the system used for the brain biopsy. METHODS Frameless stereotactic robot-assisted biopsies were performed on 32 consecutive patients. Post-operative CT and MRI scans were assessed to precisely measure and calculate target point error (TPE) and entry point error (EPE). RESULTS The application accuracy of the RONNA system for TPE was 1.95 ± 1.11 mm, while for EPE was 1.42 ± 0.74 mm. The total diagnostic yield was 96.87%. Linear regression showed statistical significance between the TPE and EPE, and the angle of the trajectory on the bone. CONCLUSION The RONNA G4 robotic system is a precise and highly accurate autonomous neurosurgical assistant for performing frameless brain biopsies.
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Affiliation(s)
- Domagoj Dlaka
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Marko Švaco
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia.,Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Darko Chudy
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia.,Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia.,Department of Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Bojan Jerbić
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia.,Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Bojan Šekoranja
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia.,Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Filip Šuligoj
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia.,Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Josip Vidaković
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia.,Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Dominik Romić
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Marina Raguž
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia.,Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
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35
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Zanello M, Roux A, Debacker C, Peeters S, Edjlali-Goujon M, Dhermain F, Dezamis E, Oppenheim C, Lechapt-Zalcman E, Harislur M, Varlet P, Chretien F, Devaux B, Pallud J. Postoperative intracerebral haematomas following stereotactic biopsies: Poor planning or poor execution? Int J Med Robot 2021; 17:e2211. [PMID: 33345461 DOI: 10.1002/rcs.2211] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/14/2020] [Accepted: 12/15/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Postoperative intracerebral haematomas represent a serious complication following stereotactic biopsy. We investigated the possible underlying causes - poor planning or poor execution - of postoperative intracerebral haematomas following stereotactic biopsies. METHODS We performed a technical investigation using a retrospective single-centre consecutive series of robot-assisted stereotactic biopsies for a supratentorial diffuse glioma in adults. Each actual biopsy trajectory was reviewed to search for a conflict with an anatomical structure at risk. RESULTS From 379 patients, 12 (3.2%) presented with a postoperative intracerebral haematoma ≥20 mm on postoperative CT-scan (3 requiring surgical evacuation); 11 of them had available intraoperative imaging (bi-planar stereoscopic teleangiography x-rays at each biopsy site). The actual biopsy trajectory was similar to the planned biopsy trajectory in these 11 cases. In 72.7% (8/11) of these cases, the actual biopsy trajectory was found to contact a structure at risk (blood vessel and cerebral sulcus) and identified as the intracerebral haematoma origin. CONCLUSIONS Robot-assisted stereotactic biopsy is an accurate procedure. Postoperative intracerebral haematomas mainly derive from human-related errors during trajectory planning.
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Affiliation(s)
- Marc Zanello
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Alexandre Roux
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Clément Debacker
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Sophie Peeters
- Department of Neurosurgery, University of California, Los Angeles, California, USA
| | - Myriam Edjlali-Goujon
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Service de Neuroradiologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Frédéric Dhermain
- Département d'Oncologie Radiothérapie, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Edouard Dezamis
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Catherine Oppenheim
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Service de Neuroradiologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Emmanuèle Lechapt-Zalcman
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Service de Neuropathologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Marc Harislur
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Pascale Varlet
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Service de Neuropathologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Fabrice Chretien
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Service de Neuropathologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Bertrand Devaux
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Johan Pallud
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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Krauss P, Van Niftrik CHB, Muscas G, Scheffler P, Oertel MF, Stieglitz LH. How to avoid pneumocephalus in deep brain stimulation surgery? Analysis of potential risk factors in a series of 100 consecutive patients. Acta Neurochir (Wien) 2021; 163:177-184. [PMID: 32960362 DOI: 10.1007/s00701-020-04588-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Accuracy of lead placement is the key to success in deep brain stimulation (DBS). Precise anatomic stereotactic planning usually is based on stable perioperative anatomy. Pneumocephalus due to intraoperative CSF loss is a common procedure-related phenomenon which could lead to brain shift and targeting inaccuracy. The aim of this study was to evaluate potential risk factors of pneumocephalus in DBS surgery. METHODS We performed a retrospective single-center analysis in patients undergoing bilateral DBS. We quantified the amount of pneumocephalus by postoperative CT scans and corrected the data for accompanying brain atrophy by an MRI-based score. Automated computerized segmentation algorithms from a dedicated software were used. As potential risk factors, we evaluated the impact of trephination size, the number of electrode tracks, length of surgery, intraoperative blood pressure, and brain atrophy. RESULTS We included 100 consecutive patients that underwent awake DBS with intraoperative neurophysiological testing. Systolic and mean arterial blood pressure showed a substantial impact with an inverse correlation, indicating that lower blood pressure is associated with higher volume of pneumocephalus. Furthermore, the length of surgery was clearly correlated to pneumocephalus. CONCLUSION Our analysis identifies intraoperative systolic and mean arterial blood pressure as important risk factors for pneumocephalus in awake stereotactic surgery.
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Affiliation(s)
- Philipp Krauss
- Department of Neurosurgery, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Christiaan Hendrik Bas Van Niftrik
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
| | - Giovanni Muscas
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
- Department of Neurosurgery, Careggi University Hospital Florence, Florence, Italy
| | - Pierre Scheffler
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
| | - Markus Florian Oertel
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
| | - Lennart Henning Stieglitz
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
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Gupta M, Chan TM, Santiago-Dieppa DR, Yekula A, Sanchez CE, Elster JD, Crawford JR, Levy ML, Gonda DD. Robot-assisted stereotactic biopsy of pediatric brainstem and thalamic lesions. J Neurosurg Pediatr 2020; 27:317-324. [PMID: 33361479 DOI: 10.3171/2020.7.peds20373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Biopsies of tumors located in deep midline structures require highly accurate stereotaxy to safely obtain lesional tissue suitable for molecular and histological analysis. Versatile platforms are needed to meet a broad range of technical requirements and surgeon preferences. The authors present their institutional experience with the robotic stereotactic assistance (ROSA) system in a series of robot-assisted biopsies of pediatric brainstem and thalamic tumors. METHODS A retrospective analysis was performed of 22 consecutive patients who underwent 23 stereotactic biopsies of brainstem or thalamic lesions using the ROSA platform at Rady Children's Hospital in San Diego between December 2015 and January 2020. RESULTS The ROSA platform enabled rapid acquisition of lesional tissue across various combinations of approaches, registration techniques, and positioning. No permanent deficits, major adverse outcomes, or deaths were encountered. One patient experienced temporary cranial neuropathy, and 3 developed small asymptomatic hematomas. The diagnostic success rate of the ROSA system was 91.3%. CONCLUSIONS Robot-assisted stereotactic biopsy of these lesions may be safely performed using the ROSA platform. This experience comprises the largest clinical series to date dedicated to robot-assisted biopsies of brainstem and diencephalic tumors.
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Affiliation(s)
- Mihir Gupta
- 1Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Tiffany M Chan
- 2Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Anudeep Yekula
- 3Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Carlos E Sanchez
- 4Department of Neurosurgery, Children's National Health System, Washington, DC; and
| | | | | | - Michael L Levy
- 1Department of Neurosurgery, University of California, San Diego, La Jolla, California.,6Division of Neurosurgery, Rady Children's Hospital, San Diego, California
| | - David D Gonda
- 1Department of Neurosurgery, University of California, San Diego, La Jolla, California.,6Division of Neurosurgery, Rady Children's Hospital, San Diego, California
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Machetanz K, Grimm F, Schuhmann M, Tatagiba M, Gharabaghi A, Naros G. Time Efficiency in Stereotactic Robot-Assisted Surgery: An Appraisal of the Surgical Procedure and Surgeon's Learning Curve. Stereotact Funct Neurosurg 2020; 99:25-33. [PMID: 33017833 DOI: 10.1159/000510107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Frame-based stereotactic procedures are still the gold standard in neurosurgery. However, there is an increasing interest in robot-assisted technologies. Introducing these increasingly complex tools in the clinical setting raises the question about the time efficiency of the system and the essential learning curve of the surgeon. METHODS This retrospective study enrolled a consecutive series of patients undergoing a robot-assisted procedure after first system installation at one institution. All procedures were performed by the same neurosurgeon to capture the learning curve. The objective read-out were the surgical procedure time (SPT), the skin-to-skin time, and the intraoperative registration time (IRT) after laser surface registration (LSR), bone fiducial registration (BFR), and skin fiducial registration (SFR), as well as the quality of the registration (as measured by the fiducial registration error [FRE]). The time measures were compared to those for a patient group undergoing classic frame-based stereotaxy. RESULTS In the first 7 months, we performed 31 robot-assisted surgeries (26 biopsies, 3 stereotactic electroencephalography [SEEG] implantations, and 2 endoscopic procedures). The SPT was depending on the actual type of surgery (biopsies: 85.0 ± 36.1 min; SEEG: 154.9 ± 75.9 min; endoscopy: 105.5 ± 1.1 min; p = 0.036). For the robot-assisted biopsies, there was a significant reduction in SPT within the evaluation period, reaching the level of frame-based surgeries (58.1 ± 17.9 min; p < 0.001). The IRT was depending on the applied registration method (LSR: 16.7 ± 2.3 min; BFR: 3.5 ± 1.1 min; SFR: 3.5 ± 1.6 min; p < 0.001). In contrast to BFR and SFR, there was a significant reduction in LSR time during that period (p = 0.038). The FRE differed between the applied registration methods (LSR: 0.60 ± 0.17 mm; BFR: 0.42 ± 0.15 mm; SFR: 2.17 ± 0.78 mm; p < 0.001). There was a significant improvement in LSR quality during the evaluation period (p = 0.035). CONCLUSION Introducing stereotactic, robot-assisted surgery in an established clinical setting initially necessitates a prolonged intraoperative preparation time. However, there is a steep learning curve during the first cases, reaching the time level of classic frame-based stereotaxy. Thus, a stereotactic robot can be integrated into daily routine within a decent period of time, thereby expanding the neurosurgeons' armamentarium, especially for procedures with multiple trajectories.
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Affiliation(s)
- Kathrin Machetanz
- Department of Neurosurgery, Eberhardt Karls University of Tübingen, Tübingen, Germany.,Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Florian Grimm
- Department of Neurosurgery, Eberhardt Karls University of Tübingen, Tübingen, Germany.,Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Martin Schuhmann
- Department of Neurosurgery, Eberhardt Karls University of Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhardt Karls University of Tübingen, Tübingen, Germany
| | - Alireza Gharabaghi
- Department of Neurosurgery, Eberhardt Karls University of Tübingen, Tübingen, Germany.,Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Georgios Naros
- Department of Neurosurgery, Eberhardt Karls University of Tübingen, Tübingen, Germany, .,Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany,
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Wu S, Wang J, Gao P, Liu W, Hu F, Jiang W, Lei T, Shu K. A comparison of the efficacy, safety, and duration of frame-based and Remebot robot-assisted frameless stereotactic biopsy. Br J Neurosurg 2020; 35:319-323. [PMID: 32940070 DOI: 10.1080/02688697.2020.1812519] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to compare the efficacy, safety, and duration of Remebot robot-assisted frameless brain biopsy with those of standard frame-based stereotactic biopsy. PATIENTS AND METHODS A retrospective analysis of 66 patients undergoing stereotactic brain biopsy in our department from January 2015 to January 2019 was performed. We divided the patients into two groups: the frame-based group (n = 35) and the Remebot robot group (n = 31). Data on clinical characteristics, total procedure length, overall discomfort, diagnostic yield, complications, and postoperative length of hospital stay were retrospectively reviewed and compared between these two groups. RESULTS No significant difference in diagnostic yield was detected in the two groups, with frame-based biopsy having a diagnostic yield of 91.4% and Remebot robot-assisted frameless brain biopsy having a diagnostic yield of 93.5%. The duration of the total procedure was 116.5 min for the frame-based biopsy and 80.1 min for the Remebot robot-assisted frameless brain biopsy (p < 0.001). There were no statistically significant differences in complication rate or postoperative duration of hospitalization between the two groups. The overall patient discomfort in the frame-based group was significantly greater than that in the Remebot robot group (visual analog scale score 2.7 ± 1.2 versus 1.5 ± 0.7, p = 0.001). CONCLUSIONS Remebot robot-assisted frameless brain biopsy was as efficacious and safe as standard stereotactic frame-based biopsy. However, frameless biopsy can alleviate the suffering of the patient and reduce the total duration of the procedure. Remebot robot-assisted frameless brain biopsy is easy to use and better accepted by patients than frame-based biopsy.
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Affiliation(s)
- Shiqiang Wu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junwen Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pan Gao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weihua Liu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Hu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Jiang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Lei
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Malinova V, von Eckardstein K, Mielke D, Rohde V. Diagnostic yield of fluorescence-assisted frame-based stereotactic biopsies of intracerebral lesions in comparison with frozen-section analysis. J Neurooncol 2020; 149:315-323. [PMID: 32852725 DOI: 10.1007/s11060-020-03608-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/23/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Stereotactic biopsies are routinely used to establish a histological diagnosis of unclear cerebral pathologies. Intraoperatively, frozen-section analysis often confirms diagnostic tissue but also exhibits methodological pitfalls. Intraoperative five-aminolevulinic acid (5-ALA)-fluorescence has been described not only in gliomas but also in other cerebral pathologies. In this study, we assessed the 5-ALA contribution to the intraoperative confirmation of diagnostic tissue in frame-based stereotactic biopsies of unclear intracerebral lesions in direct comparison with frozen-section analysis. METHODS Patients scheduled for stereotactic biopsies of unclear intracerebral pathologies received 5-ALA preoperatively. Obtained samples were intraoperatively analyzed for the presence of 5-ALA-fluorescence. One sample was used for frozen-section and a second one for permanent histopathological analysis. The diagnostic yield of frozen-section and intraoperative 5-ALA-fluorescence was calculated. The inclusion criteria for this retrospective analysis were unclear intracerebral lesions with inconclusive imaging findings and several differential diagnoses. RESULTS A total of 39 patients with 122 obtained specimens were included. The overall diagnostic yield was 92.3%. 5-ALA-positive samples were obtained in 74.3% (29/39) of patients and all these samples contained diagnostic tissue. 5-ALA-fluorescence confirmed diagnostic tissue with a sensitivity of 100%, a specificity of 27%, a positive predictive value (PPV) of 78%, and a negative predictive value (NPV) of 100%. A clear diagnosis could be predicted by frozen section with a sensitivity of 80%, a specificity of 100%, a PPV of 100%, and NPV of 30%; Fisher's exact test p = 0.01. CONCLUSION The 5-ALA-fluorescence in stereotactic biopsies of unclear intracerebral pathologies exhibits a high PPV/NPV for intraoperative confirmation of diagnostic tissue and might increase the diagnostic yield of the procedure by overcoming some of the limitations of frozen-section.
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Affiliation(s)
- Vesna Malinova
- Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Kajetan von Eckardstein
- Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.,Department of Neurosurgery, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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Joud A, Stella I, Klein O. Diffuse infiltrative pontine glioma biopsy in children with neuronavigation, frameless procedure: A single center experience of 10 cases. Neurochirurgie 2020; 66:345-348. [PMID: 32860812 DOI: 10.1016/j.neuchi.2020.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study presented pediatric DIPG 's biopsy with frameless Neuronavigation. PATIENTS AND METHODS We report our experience about 10 patients who had Diffuse Intrinsic Pontine Glioma between 2014 and 2018. All patients were biopsied with BrainLab Varioguide Neuronavigation®. We always used fusion between specific CT Scan and MRI to selected target, made planning and biopsies. All patients were included in BIOMEDE after scientific and ethic discussions. We always selected a trans-cerebellar trajectory and made same procedure (lot of biopsies at one level). All patients have MRI at J1 to verify site of biopsy and to eliminate complication. RESULTS The average age was 8.1 years. Symptoms were common with principally headaches and nystagmus. All biopsies were contributive for histopathological diagnosis and establish molecular profile for molecular study. We have no definitive morbidity and procedure duration was 93minutes in average. All MRI didn't showed intracranial complication after procedure and showed great precision of biopsy compared with the selected target. DISCUSSION We reviewed the literature and compare our results with series of DIPG biopsies using stereotactic frame or robotic assisted frameless. It was a safe, accuracy and easiness procedure. We always have histopathological and molecular result to proceed next step of treatment. This modality is an alternative possibility to biopsy very young patients with low morbidity.
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Affiliation(s)
- A Joud
- Department of Pediatric Neurosurgery, Nancy University Hospital, Hôpital d'Enfants, University of Lorraine, rue du Morvan, 54511 Vandoeuvre-les-Nancy cedex, France.
| | - I Stella
- Department of Pediatric Neurosurgery, Nancy University Hospital, Hôpital d'Enfants, University of Lorraine, rue du Morvan, 54511 Vandoeuvre-les-Nancy cedex, France
| | - O Klein
- Department of Pediatric Neurosurgery, Nancy University Hospital, Hôpital d'Enfants, University of Lorraine, rue du Morvan, 54511 Vandoeuvre-les-Nancy cedex, France
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Bonda DJ, Pruitt R, Goldstein T, Varghese A, Mittler M, Schneider S, Shah A, Rodgers S. Robotic Surgical Assistant (ROSA™) Rehearsal: Using 3-Dimensional Printing Technology to Facilitate the Introduction of Stereotactic Robotic Neurosurgical Equipment. Oper Neurosurg (Hagerstown) 2020; 19:94-97. [PMID: 31586195 DOI: 10.1093/ons/opz281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/10/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The use of frameless stereotactic robotic technology has rapidly expanded since the Food and Drug Administration's approval of the Robotic Surgical Assistant (ROSA™) in 2012. Although the safety and accuracy of the ROSA platform has been well-established, the introduction of complex robotic technology into an existing surgical practice poses technical and logistical challenges particular to a given institution. OBJECTIVES To better facilitate the integration of new surgical equipment into the armamentarium of a thriving pediatric neurosurgery practice by describing the use of a three-dimensional (3D)-printed patient model with in situ 3D-printed tumor for presurgical positioning and trajectory optimization in the stereotactic biopsy of a pontine lesion in a pediatric patient. METHODS A 3D model was created with an added silicone mock tumor at the anatomical position of the lesion. In a preoperative rehearsal session, the patient model was pinned and registered using the ROSA platform, and a mock biopsy was performed targeting the in Situ silicone tumor. RESULTS Utilization of the 3D-printed model enabled workflow optimization and increased staff familiarity with the logistics of the robotic technology. Biopsy trajectory successfully reached intralesional tissue on the 3D-printed model. The rehearsal maneuvers decreased operative and intubation time for the patient and improved operative staff familiarity with the robotic setup. CONCLUSION Use of a 3D-printed patient model enhanced presurgical positioning and trajectory planning in the biopsy of a difficult to reach pontine lesion in a pediatric patient. The ROSA rehearsal decreased operative time and increased staff familiarity with a new complex surgical equipment.
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Affiliation(s)
- David J Bonda
- Department of Neurosurgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, New York
| | - Rachel Pruitt
- Department of Neurosurgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, New York
| | - Todd Goldstein
- Center for 3D Design and Innovation, Northwell Health, Manhasset, New York
| | - Anish Varghese
- Center for 3D Design and Innovation, Northwell Health, Manhasset, New York
| | - Mark Mittler
- Department of Neurosurgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, New York
| | - Steven Schneider
- Department of Neurosurgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, New York
| | - Amar Shah
- Department of Radiology, Long Island Jewish Hospital, Northwell Health, New Hyde Park, New York
| | - Shaun Rodgers
- Department of Neurosurgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, New York
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Laville A, Coutte A, Capel C, Maroote J, Lefranc M. Dosimetric and volumetric outcomes of combining cyst puncture through an Ommaya reservoir with index-optimized hypofractionated stereotactic radiotherapy in the treatment of craniopharyngioma. Clin Transl Radiat Oncol 2020; 23:66-71. [PMID: 32490217 PMCID: PMC7256109 DOI: 10.1016/j.ctro.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/26/2022] Open
Abstract
Large cystic craniopharyngioma management combining cyst puncture through an Ommaya reservoir with hypofractionated stereotactic radiotherapy was evaluated. The planning optimization was focused on the gradient and selectivity. Punctured and filled cyst treatment plans were compared with a retrospective analysis of volumetric and functional outcomes.
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Affiliation(s)
- Adrien Laville
- Department of Radiation Oncology, University Hospital, Amiens, France
| | - Alexandre Coutte
- Department of Radiation Oncology, University Hospital, Amiens, France
| | - Cyrille Capel
- Department of Neurosurgery, University Hospital, Amiens, France
| | - Justine Maroote
- Department of Radiation Oncology, University Hospital, Amiens, France
| | - Michel Lefranc
- Department of Neurosurgery, University Hospital, Amiens, France
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Minchev G, Kronreif G, Ptacek W, Kettenbach J, Micko A, Wurzer A, Maschke S, Wolfsberger S. Frameless Stereotactic Brain Biopsies: Comparison of Minimally Invasive Robot-Guided and Manual Arm-Based Technique. Oper Neurosurg (Hagerstown) 2020; 19:292-301. [DOI: 10.1093/ons/opaa123] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/17/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Most brain biopsies are still performed with the aid of a navigation-guided mechanical arm. Due to the manual trajectory alignment without rigid skull contact, frameless aiming devices are prone to considerably lower accuracy.
OBJECTIVE
To compare a novel minimally invasive robot-guided biopsy technique with rigid skull fixation to a standard frameless manual arm biopsy procedure.
METHODS
Accuracy, procedural duration, diagnostic yield, complication rate, and cosmetic result were retrospectively assessed in 40 consecutive cases of frameless stereotactic biopsies and compared between a minimally invasive robotic technique using the iSYS1 guidance device (iSYS Medizintechnik GmbH) (robot-guided group [ROB], n = 20) and a manual arm-based technique (group MAN, n = 20).
RESULTS
Application of the robotic technique resulted in significantly higher accuracy at entry point (group ROB median 1.5 mm [0.4-3.2 mm] vs manual arm-based group (MAN) 2.2 mm [0.2-5.2 mm], P = .019) and at target point (group ROB 1.5 mm [0.4-2.8 mm] vs group MAN 2.8 mm [1.4-4.9 mm], P = .001), without increasing incision to suture time (group ROB 30.0 min [20-45 min vs group MAN 32.5 min [range 20-60 min], P = .09) and significantly shorter skin incision length (group ROB 16.3 mm [12.7-23.4 mm] vs group MAN 24.2 mm [18.0-37.0 mm], P = .008).
CONCLUSION
According to our data, the proposed technique of minimally invasive robot-guided brain biopsies can improve accuracy without increasing operating time while being equally safe and effective compared to a standard frameless arm-based manual biopsy technique.
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Affiliation(s)
- Georgi Minchev
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Gernot Kronreif
- Austrian Center for Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria
| | - Wolfgang Ptacek
- Austrian Center for Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria
| | - Joachim Kettenbach
- Institute of Diagnostic, Interventional Radiology and Nuclear Medicine, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Alexander Micko
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Ayguel Wurzer
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Svenja Maschke
- Department of Neurosurgery, Medical University of Vienna, Austria
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Bonda DJ, Pruitt R, Goldstein T, Varghese A, Shah A, Rodgers S. Robotic Surgical Assistant Rehearsal: Combining 3-Dimensional-Printing Technology With Preoperative Stereotactic Planning for Placement of Stereoencephalography Electrodes. Oper Neurosurg (Hagerstown) 2019; 19:190-194. [DOI: 10.1093/ons/opz372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/20/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
The use of frameless stereotactic robotic technology has rapidly expanded since the Food and Drug Administration's approval of the Robotic Surgical Assistant (ROSA) in 2012. Although the use of the ROSA robot has greatly augmented stereotactic placement of intracerebral stereoelectroencephalography (sEEG) for the purposes of epileptogenic focus identification, the preoperative planning stages remain limited to computer software.
OBJECTIVE
To describe the use of a 3-dimensionally (3D)-printed patient model in the preoperative planning of ROSA-assisted depth electrode placement for epilepsy monitoring in a pediatric patient.
METHODS
An anatomically accurate 3D model was created and registered in a preoperative rehearsal session using the ROSA platform. After standard software-based electrode trajectory planning, sEEG electrodes were sequentially placed in the 3D model.
RESULTS
Utilization of the 3D-printed model enabled workflow optimization and increased staff familiarity with the logistics of the robotic technology as it relates to depth electrode placement. The rehearsal maneuvers enabled optimization of patient head positioning as well as identification of physical conflicts between 2 electrodes. This permitted revision of trajectory planning in anticipation of the actual case, thereby improving patient safety and decreasing operative time.
CONCLUSION
Use of a 3D-printed patient model enhanced presurgical positioning and trajectory planning in the placement of stereotactic sEEG electrodes for epilepsy monitoring in a pediatric patient. The ROSA rehearsal decreased operative time and increased efficiency of electrode placement.
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Affiliation(s)
- David J Bonda
- Department of Neurosurgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, New York
| | - Rachel Pruitt
- Department of Neurosurgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, New York
| | - Todd Goldstein
- Center for 3D Design and Innovation, Northwell Health, Manhasset, New York
| | - Anish Varghese
- Center for 3D Design and Innovation, Northwell Health, Manhasset, New York
| | - Amar Shah
- Department of Radiology, Long Island Jewish Hospital at Northwell Health, New Hyde Park, New York
| | - Shaun Rodgers
- Department of Neurosurgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, New York
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Giamouriadis A, Perera D, Safdar A, Vergani F, Bhangoo R, Gullan R, Ashkan K. Safety and accuracy of frameless electromagnetic-navigated (AXIEM TM)-guided brain lesion biopsies: a large single-unit study. Acta Neurochir (Wien) 2019; 161:2587-2593. [PMID: 31642996 DOI: 10.1007/s00701-019-04093-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/01/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Brain biopsies are required to establish a definitive histological diagnosis for brain lesions that have been identified on imaging in order to guide further treatment for patients. OBJECTIVE Various navigation systems are in use but little up to date evidence is available regarding the safety and accuracy of a frameless, electromagnetic technique to target brain lesions. METHODS Data was collected retrospectively on all patients that had brain biopsies at our institution from 01/01/2010 to 31/12/2017. Operation notes, neuropathology reports, and clinical notes on electronic patient record were used to determine whether biopsy of adequate identifiable abnormal tissue was achieved, whether a definitive diagnosis was established, any adverse events occurred, and if a repeat biopsy was carried out. RESULTS Three hundred seventy-one AxiEM (Medtronic, Minneapolis, USA)-guided brain tumor biopsies were performed in this 8-year period. Three hundred forty-nine (94.07%) procedures provided definitive tissue diagnosis, 22 (5.93%) were non diagnostic; in 6 cases (1.62%), repeat biopsy was performed and adverse events which caused clinical compromise were observed in 4 patients (1.08%). CONCLUSIONS The AxiEM is a fast, effective, and safe frameless and pinless neuronavigational system. It offers a high degree of accuracy required for the establishment of a definitive diagnosis, permitting optimal further treatment, and thus improving patient outcomes.
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Affiliation(s)
| | | | | | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Ranjeev Bhangoo
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
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Fomenko A, Serletis D. Robotic Stereotaxy in Cranial Neurosurgery: A Qualitative Systematic Review. Neurosurgery 2019; 83:642-650. [PMID: 29253265 DOI: 10.1093/neuros/nyx576] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/01/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Modern-day stereotactic techniques have evolved to tackle the neurosurgical challenge of accurately and reproducibly accessing specific brain targets. Neurosurgical advances have been made in synergy with sophisticated technological developments and engineering innovations such as automated robotic platforms. Robotic systems offer a unique combination of dexterity, durability, indefatigability, and precision. OBJECTIVE To perform a systematic review of robotic integration for cranial stereotactic guidance in neurosurgery. Specifically, we comprehensively analyze the strengths and weaknesses of a spectrum of robotic technologies, past and present, including details pertaining to each system's kinematic specifications and targeting accuracy profiles. METHODS Eligible articles on human clinical applications of cranial robotic-guided stereotactic systems between 1985 and 2017 were extracted from several electronic databases, with a focus on stereotactic biopsy procedures, stereoelectroencephalography, and deep brain stimulation electrode insertion. RESULTS Cranial robotic stereotactic systems feature serial or parallel architectures with 4 to 7 degrees of freedom, and frame-based or frameless registration. Indications for robotic assistance are diversifying, and include stereotactic biopsy, deep brain stimulation and stereoelectroencephalography electrode placement, ventriculostomy, and ablation procedures. Complication rates are low, and mainly consist of hemorrhage. Newer systems benefit from increasing targeting accuracy, intraoperative imaging ability, improved safety profiles, and reduced operating times. CONCLUSION We highlight emerging future directions pertaining to the integration of robotic technologies into future neurosurgical procedures. Notably, a trend toward miniaturization, cost-effectiveness, frameless registration, and increasing safety and accuracy characterize successful stereotactic robotic technologies.
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Affiliation(s)
- Anton Fomenko
- Manitoba Neurosurgery Laboratory, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Section of Neurosurgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Demitre Serletis
- Manitoba Neurosurgery Laboratory, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Section of Neurosurgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
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Sciortino T, Fernandes B, Conti Nibali M, Gay LG, Rossi M, Lopci E, Colombo AE, Elefante MG, Pessina F, Bello L, Riva M. Frameless stereotactic biopsy for precision neurosurgery: diagnostic value, safety, and accuracy. Acta Neurochir (Wien) 2019; 161:967-974. [PMID: 30895395 DOI: 10.1007/s00701-019-03873-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/06/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stereotactic biopsy is consistently employed to characterize cerebral lesions in patients who are not suitable for microsurgical resection. In the past years, technical improvement and neuroimaging advancements contributed to increase the diagnostic yield, the safety, and the application of this procedure. Currently, in addition to histological diagnosis, the molecular analysis is considered essential in the diagnostic process to properly select therapeutic and prognostic algorithms in a personalized approach. The present study reports our experience with frameless stereotactic brain biopsy in this molecular era. METHODS One hundred forty consecutive patients treated from January 2013 to September 2018 were analyzed. Biopsies were performed using the Brainlab Varioguide® frameless stereotactic system. Patients' clinical and demographic data, the time of occupation of the operating room, the surgical time, the morbidity, and the diagnostic yield in providing a histological and molecular diagnosis were recorded and evaluated. RESULTS The overall diagnostic yield was 93.6% with nine procedures resulting non-diagnostic. Among 110 patients with glioma, the IDH-1 mutational status was characterized in 108 cases (98.2%), resulting wild-type in all subjects but 3; MGMT methylation was characterized in 96 cases (87.3%), resulting present in 60 patients, and 1p/19q codeletion was founded in 6 of the 20 cases of grade II-III gliomas analyzed. All the specimens were apt for molecular analysis when performed. Bleeding requiring surgical drainage occurred in 2.1% of the cases; 8 (5.7%) asymptomatic hemorrhages requiring no treatment were observed. No biopsy-related mortality was recorded. Median length of hospital stay was 5 days (IQR 4-8) with mean surgical time of 60.77 min (± 23.12) and 137.44 ± 24.1 min of total occupation time of the operative room. CONCLUSIONS Stereotactic frameless biopsy is a safe, feasible, and fast procedure to obtain a histological and molecular diagnosis.
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Affiliation(s)
- Tommaso Sciortino
- Università degli Studi di Milano, Milan, Italy
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Bethania Fernandes
- Unit of Pathology, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Marco Conti Nibali
- Università degli Studi di Milano, Milan, Italy
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Lorenzo G Gay
- Università degli Studi di Milano, Milan, Italy
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Marco Rossi
- Università degli Studi di Milano, Milan, Italy
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Egesta Lopci
- Unit of Nuclear Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Anna E Colombo
- Unit of Pathology, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Maria G Elefante
- Unit of Pathology, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Federico Pessina
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano (MI), Italy
| | - Lorenzo Bello
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Marco Riva
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy.
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy.
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Sayari AJ, Pardo C, Basques BA, Colman MW. Review of robotic-assisted surgery: what the future looks like through a spine oncology lens. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:224. [PMID: 31297389 DOI: 10.21037/atm.2019.04.69] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent advancements in medical technology have led to the emergence of robotic-assisted surgery with the hope of creating a safer and more efficient surgical environment for the patient and surgical team. Spine surgery and spine tumor surgery involve challenging anatomy and demand highly precise surgical maneuvers, creating an important niche for robotic systems. While still in its infancy, robotics in spine surgery have proven successful in pedicle screw placement. Similarly, robotics has begun to be used for accurate resections and surgical planning in tumor surgery. As future studies are published and robotics systems continue to evolve, we can expect more tactile haptic feedback and implementation of useful instruments to improve preoperative planning, resection guidance, and reconstruction during spine tumor surgery.
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Affiliation(s)
- Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Coralie Pardo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Stereotactic brain biopsy: evaluation of robot-assisted procedure in 60 patients. Acta Neurochir (Wien) 2019; 161:545-552. [PMID: 30675655 DOI: 10.1007/s00701-019-03808-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/12/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Frameless stereotactic biopsies, particularly robot-assisted procedures are increasing in neurosurgery centers. Results of these procedures should be at least equal to or greater than frame-based reference procedure. Evaluate robot-assisted technology is necessary in particular, when a team has chosen to switch from one to another method. OBJECTIVE The objective of our prospective work was (i) to evaluate the success rate of contributive robotic-assisted biopsy in 60 patients, to report the morbidity and mortality associated with the procedure and (ii) to compare it with literature data. METHODS We performed a prospective and descriptive study including 60 consecutive patients having had robotic-assisted stereotactic biopsy at the Rouen University Hospital, France. All patients had presurgical imaging before the procedure included Magnetic Resonance Imaging merged with Computed Tomography scan acquisition. Registration was mostly performed with a touch-free laser (57/60). A control Computed Tomography scan was always realized at day 0 or day 1 after surgery. Data collected were success rate, bleeding, clinical worsening, infection, and mortality. RESULTS All the biopsies were considered as contributive and lead to the final diagnosis. In 41/60 patients (68%), the lesion was glial. Six in 60 patients (10%) had visible bleeding without clinical worsening related, 5/60 patients (8.5%) showed clinical impairment following surgery, which was permanent in 2 patients, and 1/60 patient presented generalized seizures. We did not report any infection and mortality. CONCLUSION Robot-assisted frameless surgery is efficient and provides a reasonable alternative to frame-based procedure. The operating time can be reduced, without increasing morbidity and mortality rates.
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