Frameless Stereotactic Brain Biopsies: Comparison of Minimally Invasive Robot-Guided and Manual Arm-Based Technique

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.

Stereotactic biopsy for adult brainstem lesions: A surgical approach and its diagnostic value according to the 2016 World Health Organization Classification

“…8 Recently, with the advancement of neuronavigation technologies, frameless stereotactic brain biopsy and robot-assisted stereotactic brain biopsy have been introduced. [38][39][40][41] Recent studies have reported that the stability and efficiency of these new technologies are equivalent to those of standard frame-based stereotactic biopsy. We have also started using robot-assisted surgery to implant electrodes in patients with epilepsy, with accuracy and safety similar to those of conventional stereotactic procedures.…”

Frameless stereotactic brain biopsy: A prospective study on robot‐assisted brain biopsies performed on 32 patients by using the RONNA G4 system

“…reported a series of 40 cases of frameless stereotactic biopsies and compared a minimally invasive robotic technique using the iSYS1 robot (iSYS Medizintechnik GmbH) with a manual arm‐based technique. Using robotic technique the mean EPE was 1.5 mm (range 0.4–3.2 mm) while the mean TPE was 1.5 mm (range 0.4–2.8 mm) 44 . Spyrantis et al.…”

The Safety and Efficacy of Robot-Assisted Stereotactic Biopsy for Brain Glioma: Earliest Institutional Experiences and Evaluation of Literature

“…Nowadays, similar systems have gained a pivotal role during cranial and spinal surgeries to facilitate safer and more accurate, minimally invasive procedures, as well as to provide the best possible approaches and less time-consuming interventions ( 12 ). Hence, the majority of brain tumor biopsies are now executed using a frameless navigation-guided automated arm ( 13 ).…”

“…Such systems minimize movement and increase stability while bone drilling, perform accurate skin and cortical incision placement, and specify drilling depth based on measurement of the skull thickness, enabling real-time visualization 35 . Several studies have reported a 95% up to 100% diagnostic accuracy from robot-assisted brain biopsy 9,13,36 , resulting in con-siderably lower target errors when compared to standard manual brain biopsy techniques 37 , showing markedly shorter median surgical time, and evidently lower complication rates 9,13,23,[36][37][38] . Accordingly, all samples were positive for tumor tissue, the iatrogenic cortical damage was minimal, and no procedure-related shortterm complications were recorded in the series of our patients.…”