Frameless robotic stereotactic biopsies: a consecutive series of 100 cases

Abstract

OBJECT Stereotactic biopsy procedures are an everyday part of neurosurgery. The procedure provides an accurate histological diagnosis with the least possible morbidity. Robotic stereotactic biopsy needs to be an accurate, safe, frameless, and rapid technique. This article reports the clinical results of a series of 100 frameless robotic biopsies using a Medtech ROSA device. METHODS The authors retrospectively analyzed their first 100 frameless stereotactic biopsies performed with the robotic ROSA device: 84 biopsies were performed by frameless robotic surface registration, 7 were performed by robotic bone fiducial marker registration, and 9 were performed by scalp fiducial marker registration. Intraoperative flat-panel CT scanning was performed concomitantly in 25 cases. The operative details of the robotic biopsies, the diagnostic yield, and mortality and morbidity data observed in this series are reported. RESULTS A histological diagnosis was established in 97 patients. No deaths or permanent morbidity related to surgery were observed. Six patients experienced transient neurological worsening. Six cases of bleeding within the lesion or along the biopsy trajectory were observed on postoperative CT scans but were associated with transient clinical symptoms in only 2 cases. Stereotactic surgery was performed with patients in the supine position in 93 cases and in the prone position in 7 cases. The use of fiducial markers was reserved for posterior fossa biopsy via a transcerebellar approach, via an occipital approach, or for pediatric biopsy. CONCLUSIONS ROSA frameless stereotactic biopsies appear to be accurate and safe robotized frameless procedures.

Stereotactic Biopsy of Pineal Lesions

“…Different departments use local or general anesthesia 16 , frame based and frame-less systems or intraoperative MRI and robotic assisted systems 5,7 . Even lesions in highly eloquent areas can be safely reached and also children can undergo the procedure 4,10 .…”

Review of Robotic Technology for Stereotactic Neurosurgery

“…This plan is then registered to a CT scan, performed near the time of surgery, and which serves as the reference due to its homogeneous geometric accuracy. An intraoperative Flat-Panel CT can be integrated in the surgery workflow to compensate for brain shift or robot registration errors [66], [67].…”

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“…It is easily integrated in the institution workflow and is reported to be well accepted [67]. No other robotic system offers so many options regarding robot registration.…”

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