Comparative Study of Robot-Assisted versus Conventional Frame-Based Deep Brain Stimulation Stereotactic Neurosurgery

Neudorfer, Clemens; Hunsche, S.; Hellmich, Martin; Majdoub, Faycal El; Maarouf, Mohammad

doi:10.1159/000494736

Cited by 55 publications

(54 citation statements)

References 28 publications

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“…The initial search identified 625 publications, whereas after application of language filter 436 studies remained. A total of 25 full-text papers reporting the use of intraoperative imaging in DBS surgery matched the inclusion criteria [7,8,14,18,19,21,22,24,28,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. Data reported in this study were included for qualitative and quantitative analysis, totaling 26 papers.…”

Section: Intraoperative Image In Dbs Surgery: Systematic Review Of Thmentioning

confidence: 99%

O-Arm Stereotactic Imaging in Deep Brain Stimulation Surgery Workflow: A Utility and Cost-Effectiveness Analysis

Furlanetti¹,

Hasegawa²,

Oviedova³

et al. 2020

Stereotact Funct Neurosurg

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Introduction: Deep brain stimulation (DBS) surgery is an established treatment for movement disorders. Advances in neuroimaging techniques have resulted in improved targeting accuracy that may improve clinical outcomes. This study aimed to evaluate the safety and feasibility of using the Medtronic O-arm device for the acquisition of intraoperative stereotactic imaging, targeting, and localization of DBS electrodes compared with standard stereotactic MRI or computed tomography (CT). Methods: Patients were recruited prospectively into the study. Routine frame-based stereotactic DBS surgery was performed. Intraoperative imaging was used to facilitate and verify the accurate placement of the intracranial electrodes. The acquisition of coordinates and verification of the position of the electrodes using the O-arm were evaluated and compared with conventional stereotactic MRI or CT. Additionally, a systematic review of the literature on the use of intraoperative imaging in DBS surgery was performed. Results: Eighty patients were included. The indications for DBS surgery were dystonia, Parkinson’s disease, essential tremor, and epilepsy. The globus pallidus internus was the most commonly targeted region (43.7%), followed by the subthalamic nucleus (35%). Stereotactic O-arm imaging reduced the overall surgical time by 68 min, reduced the length of time of acquisition of stereotactic images by 77%, reduced patient exposure to ionizing radiation by 24.2%, significantly reduced operating room (OR) costs per procedure by 31%, and increased the OR and neuroradiology suite availability. Conclusions: The use of the O-arm in DBS surgery workflow significantly reduced the duration of image acquisition, the exposure to ionizing radiation, and costs when compared with standard stereotactic MRI or CT, without reducing accuracy.

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Section: Intraoperative Image In Dbs Surgery: Systematic Review Of Thmentioning

confidence: 99%

O-Arm Stereotactic Imaging in Deep Brain Stimulation Surgery Workflow: A Utility and Cost-Effectiveness Analysis

Furlanetti¹,

Hasegawa²,

Oviedova³

et al. 2020

Stereotact Funct Neurosurg

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“…Prior reports of robotic stereotactic implantation for DBS devices have achieved submillimeter accuracy with average radial target errors of 0.86 mm (2,3), suggesting that for DBS surgery robotic stereotaxy has at least equivalent accuracy compared to frame-based stereotaxy. Direct comparison of robotic vs. framebased stereotaxy has also suggested that robotic stereotaxy has lower mean radial target error of 0.76 ± 0.37 mm compared to 1.11 ± 0.59 mm for frame-based implantation (6). Prior reports for robotic-assisted occipital-approach mesial temporal RNS depth electrode accuracy have not been as positive, with median radial error over 2.18 mm (7).…”

Section: Discussionmentioning

confidence: 99%

Accuracy and Workflow Improvements for Responsive Neurostimulation Hippocampal Depth Electrode Placement Using Robotic Stereotaxy

et al. 2020

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Background: Robotic stereotaxy is increasingly common in epilepsy surgery for the implantation of stereo-electroencephalography (sEEG) electrodes for intracranial seizure monitoring. The use of robots is also gaining popularity for permanent stereotactic lead implantation applications such as in deep brain stimulation and responsive neurostimulation (RNS) procedures.Objective: We describe the evolution of our robotic stereotactic implantation technique for placement of occipital-approach hippocampal RNS depth leads.Methods: We performed a retrospective review of 10 consecutive patients who underwent robotic RNS hippocampal depth electrode implantation. Accuracy of depth lead implantation was measured by registering intraoperative post-implantation fluoroscopic CT images and post-operative CT scans with the stereotactic plan to measure implantation accuracy. Seizure data were also collected from the RNS devices and analyzed to obtain initial seizure control outcome estimates.Results: Ten patients underwent occipital-approach hippocampal RNS depth electrode placement for medically refractory epilepsy. A total of 18 depth electrodes were included in the analysis. Six patients (10 electrodes) were implanted in the supine position, with mean target radial error of 1.9 ± 0.9 mm (mean ± SD). Four patients (8 electrodes) were implanted in the prone position, with mean radial error of 0.8 ± 0.3 mm. The radial error was significantly smaller when electrodes were implanted in the prone position compared to the supine position (p = 0.002). Early results (median follow-up time 7.4 months) demonstrate mean seizure frequency reduction of 26% (n = 8), with 37.5% achieving ≥50% reduction in seizure frequency as measured by RNS long episode counts.Conclusion: Prone positioning for robotic implantation of occipital-approach hippocampal RNS depth electrodes led to lower radial target error compared to supine positioning. The robotic platform offers a number of workflow advantages over traditional frame-based approaches, including parallel rather than serial operation in a bilateral case, decreased concern regarding human error in setting frame coordinates, and surgeon comfort.

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“…The rst robot-assisted stereotactic brain biopsy utilising a modi ed PUMA industrial robot was performed in 1985 with improved procedure time and intra-operative accuracy 5 . Global installations of stereotactic trajectory guidance systems increased in the last decade, with common cranial indications including brain biopsy 6 , deep brain stimulation 7 , stereoelectroencephalography (SEEG) 8, 9 and therapeutic drug delivery 10 . SEEG is a procedure in which, usually, 7-16 electrodes are stereotactically implanted within prede ned regions of the brain, to localize the source of drug-resistant focal epilepsy, in order to guide de nitive resections to cure the epilepsy 9,11 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of Robotic and Manual Implantation of Intracerebral Electrodes: A Single-Centre, Single-Blinded, Randomised Controlled Trial.

Vakharia

Rodionov

Miserocchi

et al. 2021

Preprint

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There has been a significant rise in robotic trajectory guidance devices that have been utilised for stereotactic neurosurgical procedures. These devices have significant costs and associated learning curves. Previous studies reporting devices usage have not undertaken prospective parallel-group comparisons before their introduction, so the comparative differences are unknown.We study the difference in stereoelectroencephalography electrode implantation time between a robotic trajectory guidance device (iSYS1) and manual frameless implantation (PAD) in patients with drug-refractory focal epilepsy through a single-blinded randomised control parallel-group investigation of SEEG electrode implantation, concordant with CONSORT statement.Thirty-two patients (18 male) completed the trial. The iSYS1 returned significantly shorter median operative time for intracranial bolt insertion, 6.36 min (95%CI 5.72-7.07) versus 9.06 min (95%CI 8.16- 10.06), ratio of median estimate (iSYS1/PAD) 0.70 (95%CI 0.61-0.81), p=0.0001. The PAD group had a better median target point accuracy 1.58 mm (95%CI 1.38- 1.82) versus 1.16 mm (95%CI 1.01- 1.33)), p=0.004. The mean electrode implantation angle error was 2.13o for the iSYS1 group and 1.71o for the PAD groups (p=0.023). There was no statistically significant difference for any other outcome.Health policy and hospital commissioners should consider these differences in the context of the opportunity cost of introducing robotic devices.Trial registration: ISRCTN17209025 (https://doi.org/10.1186/ISRCTN17209025)

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Comparative Study of Robot-Assisted versus Conventional Frame-Based Deep Brain Stimulation Stereotactic Neurosurgery

Cited by 55 publications

References 28 publications

O-Arm Stereotactic Imaging in Deep Brain Stimulation Surgery Workflow: A Utility and Cost-Effectiveness Analysis

O-Arm Stereotactic Imaging in Deep Brain Stimulation Surgery Workflow: A Utility and Cost-Effectiveness Analysis

Accuracy and Workflow Improvements for Responsive Neurostimulation Hippocampal Depth Electrode Placement Using Robotic Stereotaxy

Comparison of Robotic and Manual Implantation of Intracerebral Electrodes: A Single-Centre, Single-Blinded, Randomised Controlled Trial.

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