Frameless Stereotactic Robot-Assisted Subthalamic Nucleus Deep Brain Stimulation: Case Report

Vadera, Sumeet; Chan, Alvin Y.; Lo, Thomas P.; Gill, Amandip S; Morenkova, Anna; Phielipp, Nicolás; Hermanowicz, Neal; Hsu, Frank P.K.

doi:10.1016/j.wneu.2015.11.009

Cited by 42 publications

(22 citation statements)

References 15 publications

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“…Among these are traditional rigid external stereotactic frames, the Clearpoint SMARTFrame (MRI Interventions), and the ROSA robotic device (Medtech). While these offer highly accurate stereotaxis for probe insertion, 10,20 STarFix repre- sents an easily accessible means of achieving similar levels of accuracy with little to no learning curve. A significant advantage offered by the STarFix design is the ability to anchor the frame at or above the level of the superior nuchal line, where scalp tissue is relatively thin.…”

Section: Discussionmentioning

confidence: 99%

Utilizing personalized stereotactic frames for laser interstitial thermal ablation of posterior fossa and mesiotemporal brain lesions: a single-institution series

Dadey

Kamath

Smyth

et al. 2016

FOC

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OBJECTIVE The precision of laser probe insertion for interstitial thermal therapy of deep-seated lesions is limited by the method of stereotactic guidance. The objective of this study was to evaluate the feasibility of customized STarFix 3D-printed stereotactic platforms to guide laser probe insertion into mesiotemporal and posterior fossa targets. METHODS The authors conducted a retrospective review of 5 patients (12–55 years of age) treated with laser interstitial thermal therapy (LITT) in which STarFix platforms were used for probe insertion. Bone fiducials were implanted in each patient's skull, and subsequent CT scans were used to guide the design of each platform and incorporate desired treatment trajectories. Once generated, the platforms were mounted on the patients' craniums and used to position the laser probe during surgery. Placement of the laser probe and the LITT procedure were monitored with intraoperative MRI. Perioperative and follow-up MRI were performed to identify and monitor changes in target lesions. RESULTS Accurate placement of the laser probe was observed in all cases. For all patients, thermal ablation was accomplished without intraoperative complications. Of the 4 patients with symptomatic lesions, 2 experienced complete resolution of symptoms, and 1 reported improved symptoms compared with baseline. CONCLUSIONS Customized stereotactic platforms were seamlessly incorporated into the authors' previously established LITT workflow and allowed for accurate treatment delivery.

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Section: Discussionmentioning

confidence: 99%

Utilizing personalized stereotactic frames for laser interstitial thermal ablation of posterior fossa and mesiotemporal brain lesions: a single-institution series

Dadey

Kamath

Smyth

et al. 2016

FOC

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“…20,24 Cranial applications for these robots include stereotactic deep brain stimulator placement, laser thermal ablation therapy, tumors, and endoscope navigations. 6,8,18,56 In cranial surgeries, the preoperative MRI is merged with the intraoperative CT or MRI scan. The availability of intraoperative imaging can limit the use of the robot.…”

Section: 45mentioning

confidence: 99%

Augmented-reality integrated robotics in neurosurgery: are we there yet?

Madhavan¹,

Kolcun²,

Chieng³

et al. 2017

Neurosurgical Focus

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Surgical robots have captured the interest—if not the widespread acceptance—of spinal neurosurgeons. But successful innovation, scientific or commercial, requires the majority to adopt a new practice. “Faster, better, cheaper” products should in theory conquer the market, but often fail. The psychology of change is complex, and the “follow the leader” mentality, common in the field today, lends little trust to the process of disseminating new technology. Beyond product quality, timing has proven to be a key factor in the inception, design, and execution of new technologies. Although the first robotic surgery was performed in 1985, scant progress was seen until the era of minimally invasive surgery. This movement increased neurosurgeons’ dependence on navigation and fluoroscopy, intensifying the drive for enhanced precision. Outside the field of medicine, various technology companies have made great progress in popularizing co-robots (“cobots”), augmented reality, and processor chips. This has helped to ease practicing surgeons into familiarity with and acceptance of these technologies. The adoption among neurosurgeons in training is a “follow the leader” phenomenon, wherein new surgeons tend to adopt the technology used during residency. In neurosurgery today, robots are limited to computers functioning between the surgeon and patient. Their functions are confined to establishing a trajectory for navigation, with task execution solely in the surgeon’s hands. In this review, the authors discuss significant untapped technologies waiting to be used for more meaningful applications. They explore the history and current manifestations of various modern technologies, and project what innovations may lie ahead.

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“…20 The ROSA instructions recommended a conventional registration method of placing the tip of the registration probe in a position tangent to the groove of the bone screws. 6,7,16 In practice, we found that shifting the probe tip slightly off the groove might improve registration accuracy. Herein, we conducted a study to investigate the accuracy of the ROSA device, first in a skull model, then in a clinical situation.…”

mentioning

confidence: 94%

“…Administration for use in the United States. 16 We have been using ROSA for DBS surgery since 2016. 20 The ROSA instructions recommended a conventional registration method of placing the tip of the registration probe in a position tangent to the groove of the bone screws.…”

mentioning

confidence: 99%

Improved accuracy using a modified registration method of ROSA in deep brain stimulation surgery

Feng¹,

Jin²,

Yang³

et al. 2018

Neurosurgical Focus

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OBJECTIVEThe aim of this study was to determine whether a modified registration method could reduce registration error and postoperative electrode vector error and to analyze the method’s clinical significance in deep brain stimulation (DBS) surgery.METHODSThe first part of the study involved a skull model, in which three registration methods were tested using the ROSA (robotic stereotactic assistance) system. In the second part, four registration methods were clinically tested in patients undergoing DBS surgery using the ROSA system. Thirty-three patients (65 sides, group I) underwent the conventional registration method 2E, and registration errors were recorded. Thirty-eight patients (75 sides, group II) underwent four types of modified registration methods including 2A, 2B, 2C, and 2D. Registration and electrode vector errors, intraoperative electrophysiological signal length (IESL), and DBS power-on voltage were recorded. The primary measure of efficacy was the change in the Unified Parkinson’s Disease Rating Scale (UPDRS) and UPDRS Part III scores from baseline to 10 weeks after surgery.RESULTSIn the skull model, the registration error (mean ± SD) was 0.56 ± 0.11 mm for method 1A, 0.35 ± 0.11 mm for method 1B (vs. 1A, p < 0.001), and 0.90 ± 0.15 mm for method 1C (vs. 1A, p < 0.001). In the clinical study, method 2C was selected for DBS surgery in group II since it had the smallest registration error among the four methods tested. The registration error was 0.62 ± 0.22 mm (mean ± SD) for group I and 0.27 ± 0.07 mm for group II (p < 0.001). Postoperative electrode vector error was 0.97 ± 0.31 mm for group I and 0.65 ± 0.23 mm for group II (p < 0.001). There was a positive correlation between registration error and electrode vector error in both groups (group I: r = 0.69, p < 0.001; group II: r = 0.71, p < 0.001). The mean IESL was 5.0 ± 0.9 mm in group I and 5.8 ± 0.7 mm in group II (p < 0.001). The mean DBS power-on voltage was 1.63 ± 0.44 V in group I and 1.48 ± 0.38 V in group II (p = 0.027). In the UPDRS score, group I showed 50% ± 16% improvement and group II showed 52% ± 18% improvement (p = 0.724); there was no statistically significant difference in improvement on the UPDRS.CONCLUSIONSIn DBS surgery assisted by the ROSA system, registration error and electrode vector error showed a positive correlation. The modified registration method could reduce the registration error and electrode vector error, but the long-term effects need to be further observed and evaluated.

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Frameless Stereotactic Robot-Assisted Subthalamic Nucleus Deep Brain Stimulation: Case Report

Cited by 42 publications

References 15 publications

Utilizing personalized stereotactic frames for laser interstitial thermal ablation of posterior fossa and mesiotemporal brain lesions: a single-institution series

Utilizing personalized stereotactic frames for laser interstitial thermal ablation of posterior fossa and mesiotemporal brain lesions: a single-institution series

Augmented-reality integrated robotics in neurosurgery: are we there yet?

Improved accuracy using a modified registration method of ROSA in deep brain stimulation surgery

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