Abstract:OBJECTIVEBiopsies 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.METHODSA retrospective analysis was perfor… Show more
“…Regarding complications, compared to our bleeding rate of 2%, the literature has recorded bleeding rates between 0 and 13.1% (1,3,6,11,(15)(16)(17). One report considering 379 patients observed 12 cases (3.2%) presenting intracerebral hematoma of ≥20 ml, three of whom needed surgical cleaning (12,15), with researchers suggesting that the biopsy trajectory of most patients with hemorrhaging resulted from contact with blood vessels or cerebral sulcus (15).…”
Section: Discussionmentioning
confidence: 59%
“…One report considering 379 patients observed 12 cases (3.2%) presenting intracerebral hematoma of ≥20 ml, three of whom needed surgical cleaning ( 12 , 15 ), with researchers suggesting that the biopsy trajectory of most patients with hemorrhaging resulted from contact with blood vessels or cerebral sulcus ( 15 ). Although the safety of biopsies has generally been proven high, that brainstem and diencephalon bleeding rates can reach 13.1% may be due to the surgery's unavoidable movement through complex and abundant blood vessel tissues ( 1 ). For example, Malone et al analyzed 7,514 intracranial biopsies conducted across multiple centers, finding intracranial hemorrhaging to be the most common complication (5.8%), with multivariate logistic regression analyses associating hemorrhaging with advanced age (≥60 years) and hydrocephalus ( 17 ).…”
Section: Discussionmentioning
confidence: 99%
“…Clinically, when a patient develops an intracranial lesion that is not suitable for excision therapy and requires a tissue diagnosis to determine a proper treatment plan, the neurosurgery center prioritizes stereotactic biopsies. Stereotactic biopsy surgery can be used to treat multiple intracranial lesions, high-risk craniotomy areas—such as the brainstem and diencephalon ( 1 , 2 )—and patients whose poor health has led to intolerance to surgery. A histological diagnosis of a tumor is critical to adjuvant therapy, allowing follow-up treatment plans including radiotherapy, chemotherapy, and targeted drug therapy.…”
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.
“…Regarding complications, compared to our bleeding rate of 2%, the literature has recorded bleeding rates between 0 and 13.1% (1,3,6,11,(15)(16)(17). One report considering 379 patients observed 12 cases (3.2%) presenting intracerebral hematoma of ≥20 ml, three of whom needed surgical cleaning (12,15), with researchers suggesting that the biopsy trajectory of most patients with hemorrhaging resulted from contact with blood vessels or cerebral sulcus (15).…”
Section: Discussionmentioning
confidence: 59%
“…One report considering 379 patients observed 12 cases (3.2%) presenting intracerebral hematoma of ≥20 ml, three of whom needed surgical cleaning ( 12 , 15 ), with researchers suggesting that the biopsy trajectory of most patients with hemorrhaging resulted from contact with blood vessels or cerebral sulcus ( 15 ). Although the safety of biopsies has generally been proven high, that brainstem and diencephalon bleeding rates can reach 13.1% may be due to the surgery's unavoidable movement through complex and abundant blood vessel tissues ( 1 ). For example, Malone et al analyzed 7,514 intracranial biopsies conducted across multiple centers, finding intracranial hemorrhaging to be the most common complication (5.8%), with multivariate logistic regression analyses associating hemorrhaging with advanced age (≥60 years) and hydrocephalus ( 17 ).…”
Section: Discussionmentioning
confidence: 99%
“…Clinically, when a patient develops an intracranial lesion that is not suitable for excision therapy and requires a tissue diagnosis to determine a proper treatment plan, the neurosurgery center prioritizes stereotactic biopsies. Stereotactic biopsy surgery can be used to treat multiple intracranial lesions, high-risk craniotomy areas—such as the brainstem and diencephalon ( 1 , 2 )—and patients whose poor health has led to intolerance to surgery. A histological diagnosis of a tumor is critical to adjuvant therapy, allowing follow-up treatment plans including radiotherapy, chemotherapy, and targeted drug therapy.…”
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.
“…Ultimately, 41 articles including 2792 unique patients with brainstem lesions were eligible for the meta-analysis. 1 , 4 , 7 , 8 , 13 , 14 , 16 - 19 , 26 - 56 Figure 1. PRISMA flow diagram of study selection.…”
Section: Resultsmentioning
confidence: 99%
“…Brainstem stereotactic biopsy can be operated with CT-, MRI-, or PET-CT-guided framed navigation or with robotic frameless assistance. [16][17][18][19] Again, thanks to these new techniques, contemporary brainstem stereotactic biopsy shows high diagnostic yield and good safety. Two previous systematic reviews and meta-analyses investigating the diagnostic value and safety of brainstem stereotactic biopsy in brainstem tumors by Dr Ruge's team both found a high weighted average proportion of diagnostic success (96.1-96.2%) coupled with low overall morbidity (6.7-7.8%), permanent morbidity (.6-1.7%), and mortality (.6-.9%).…”
Objectives To evaluate the diagnostic yield and safety of brainstem stereotactic biopsy for brainstem lesions. Methods We performed a meta-analysis of English articles retrieved from the PubMed, Web of Science, Cochrane Library, and APA psycInfo databases up to May 12, 2021. A binary fixed-effect model, the inverse variance method, or a binary random-effect model, the Dersimonian Laird method, were utilized for pooling the data. This meta-analysis was registered with INPLASY, INPLASY202190034. Findings A total of 41 eligible studies with 2792 participants were included. The weighted average diagnostic yield was 97.0% (95% confidential interval [CI], 96.0-97.9%). The weighted average proportions of temporary complications, permanent deficits, and deaths were 6.2% (95% CI, 4.5–7.9%), .5% (95% CI, .2–.8%), and .3% (95% CI, .1–.5%), respectively. The subgroup analysis indicated a nearly identical weighted average diagnostic yield between MRI-guided stereotactic biopsy and CT-guided stereotactic biopsy (95.9% vs 95.8%) but slightly increased proportions of temporary complications (7.9% vs 6.0%), permanent deficits (1.9% vs .2%), and deaths (1.1% vs .4%) in the former compared to the latter. Moreover, a greater weighted average diagnostic yield (99.2% vs 97.6%) and lower proportions of temporary complications (5.1% vs 6.8%) and deaths (.7% vs 1.5%) were shown in the pediatric patient population than in the adult patient population. Conclusions Brainstem stereotactic biopsy demonstrates striking accuracy plus satisfying safety in the diagnosis of brainstem lesions. The diagnostic yield, morbidity, and mortality mildly vary based on the diversity of assistant techniques and subject populations.
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