Application of the robot-assisted implantation in deep brain stimulation

Ma, Fanyuan; Liu, Defeng; Yang, Anchao; Zhang, Kai; Meng, Fangang; Zhang, Jianguo; Liu, Huan-Guang

doi:10.3389/fnbot.2022.996685

Cited by 10 publications

(5 citation statements)

References 48 publications

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“…1 ). High-resolution post-mortem structural MRI confirmed the accurate location of the DBS electrode within the VLL (average distance between the implantation location and the VLL nucleus over animals:1.7mm +/− 0.4 mm (SE), in line with human studies 25 ). Additionally, we used HDFT between the electrode implantation region and the somatosensory, motor, and pre-motor cortical areas and confirmed that the largest volume of fibers within the stimulation area projected to M1 (on average 55% of the fibers) ( Fig.…”

Section: Resultssupporting

confidence: 72%

Potentiation of Cortico-Spinal Output via Targeted Electrical Stimulation of the Motor Thalamus

Grigsby

Damiani

et al. 2023

Preprint

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Cerebral white matter tract lesions prevent cortico-spinal descending inputs from effectively activating spinal motoneurons, leading to untreatable muscle paralysis. However, in most cases the damage to cortico-spinal axons is incomplete and the spared connections could be potentiated by neurotechnologies to restore motor function. Here we hypothesized that, by engaging direct excitatory connections to cortico-spinal motoneurons, deep brain stimulation (DBS) of the motor thalamus could facilitate activation of spared cortico-spinal fibers improving movements of the paretic limb. We first identified, in monkeys, optimal stimulation targets and parameters that enhanced motor evoked potentials to arm, hand, and face muscles, as well as grip forces. This potentiation persisted after cerebral white matter lesions. We then translated these results to human subjects by identifying the corresponding optimal thalamic targets (VIM/VOP nuclei) and replicated the results obtained in monkeys. Finally, we designed a DBS protocol that immediately improved voluntary grip force control in a patient with a chronic traumatic brain injury. Our results suggest that targeted DBS of the motor thalamus may become an effective therapy for motor paralysis.

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Section: Resultssupporting

confidence: 72%

Potentiation of Cortico-Spinal Output via Targeted Electrical Stimulation of the Motor Thalamus

Grigsby

Damiani

et al. 2023

Preprint

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“…27,28 One study reported their use of a floormounted robot with optical registration, and the only metric recorded was target radial error: 1.28 ± 0.37 (n = 60 electrodes). 29 Our meta-analysis found that the floor-mounted systems are more accurate, with a radial target error of 0.90 ± 0.46 mm (n = 1510 electrodes), compared with skull-mounted systems (1.12 ± 0.54 mm, n = 406) (P = .028). There are several different registration methods, including surface registration, frame-based registration, frameless bone fiducial registration, and frameless transient fiducial array registration.…”

Section: Meta-analysismentioning

confidence: 78%

“…27,28 One study reported their use of a floor-mounted robot with optical registration, and the only metric recorded was target radial error: 1.28 ± 0.37 (n = 60 electrodes). 29…”

Section: Resultsmentioning

confidence: 99%

Robot-Assisted Minimally Invasive Asleep Single-Stage Deep Brain Stimulation Surgery: Operative Technique and Systematic Review

Fayed,

Smit,

Vinjamuri

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Robotic assistance has garnered increased use in neurosurgery. Recently, this has expanded to include deep brain stimulation (DBS). Several studies have reported increased accuracy and improved efficiency with robotic assistance, but these are limited to individual robotic platforms with smaller sample sizes or are broader studies on robotics not specific to DBS. Our objectives are to report our technique for robot-assisted, minimally invasive, asleep, single-stage DBS surgery and to perform a meta-analysis comparing techniques from previous studies. METHODS: We performed a single-center retrospective review of DBS procedures using a floor-mounted robot with a frameless transient fiducial array registration. We compiled accuracy data (radial entry error, radial target error, and 3-dimensional target error) and efficiency data (operative time, setup time, and total procedure time). We then performed a meta-analysis of previous studies and compared these metrics. RESULTS: We analyzed 315 electrodes implanted in 160 patients. The mean radial target error was 0.9 ± 0.5 mm, mean target 3-dimensional error was 1.3 ± 0.7 mm, and mean radial entry error was 1.1 ± 0.8 mm. The mean procedure time (including pulse generator placement) was 182.4 ± 47.8 minutes, and the mean setup time was 132.9 ± 32.0 minutes. The overall complication rate was 8.8% (2.5% hemorrhagic/ischemic, 2.5% infectious, and 0.6% revision). Our meta-analysis showed increased accuracy with floor-mounted over skull-mounted robotic platforms and with fiducial-based registrations over optical registrations. CONCLUSION: Our technique for robot-assisted, minimally invasive, asleep, single-stage DBS surgery is safe, accurate, and efficient. Our data, combined with a meta-analysis of previous studies, demonstrate that robotic assistance can provide similar or increased accuracy and improved efficiency compared with traditional frame-based techniques. Our analysis also suggests that floor-mounted robots and fiducial-based registration methods may be more accurate.

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“…However, we hypothesize that personal experience is a confounding factor for accuracy and positive diagnostic rates. For this reason, we have organized an expert consensus on biopsy to reduce human factors and bias in biopsy procedure protocols (10,(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Novel application of robot-guided stereotactic technique on biopsy diagnosis of intracranial lesions

Yan¹,

Wang²,

Shan³

et al. 2023

Front. Neurol.

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IntroductionThis study was performed to examine whether there is a link between the application of three types of robot-guided stereotactic biopsy techniques and the diagnostic rate of intracranial lesion biopsy.MethodsThe study involved 407 patients who underwent robot-guided stereotactic intracranial lesion biopsy at Xuanwu Hospital of Capital Medical University from January 2019 to December 2021. Age, sex, lesion characteristics, lesion distribution, surgical method, and target path depth were assessed for their impact on the biopsy diagnostic rate.ResultsThe patients’ mean age was 42.1 years (range, 6 months–82 years). All patients underwent robot-assisted stereotactic brain biopsy using one of three different systems: a ROSA robotic system (n=35), the CAS-R-2 (n=65), or the REMEBOT domestic robotic system (n=307). No significant difference was found in the diagnostic rate of positive histopathological findings or the mean time of surgery among the three biopsy modalities. The diagnostic rate was 93.86%. Multiple linear regression analysis showed that age, sex, and biopsy modality did not affect the diagnostic rate n>0.05), whereas enhancing lesions and smaller-volume lesions (≤l cm3) were significantly correlated with the diagnostic rate (p = 0.01). Lesions located in the suprasellar and pineal regions were significantly associated with the negative diagnostic rate (p<0.05).ConclusionThe presence of enhancing lesions, lesion location, and lesion volume significantly affected the diagnostic rate of brain biopsy. Age, sex, lesion depth, and biopsy modality did not significantly affect the diagnostic rate. All three procedures had high safety and effectiveness.

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Application of the robot-assisted implantation in deep brain stimulation

Cited by 10 publications

References 48 publications

Potentiation of Cortico-Spinal Output via Targeted Electrical Stimulation of the Motor Thalamus

Potentiation of Cortico-Spinal Output via Targeted Electrical Stimulation of the Motor Thalamus

Robot-Assisted Minimally Invasive Asleep Single-Stage Deep Brain Stimulation Surgery: Operative Technique and Systematic Review

Novel application of robot-guided stereotactic technique on biopsy diagnosis of intracranial lesions

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