Frameless Robotic-Assisted Deep Brain Stimulation With the Mazor Renaissance System

Abstract

BACKGROUND: Robotic-assisted stereotactic systems for deep brain stimulation (DBS) have recently gained popularity because of their abilities to automate arduous human error-prone steps for lead implantation. Recent DBS literature focuses on frame-based robotic platforms, but little has been reported on frameless robotic approaches, specifically the Food and Drug Administration-approved Mazor Renaissance Guidance System (Mazor Robotics Ltd). OBJECTIVE: To present an initial case series for patients undergoing awake DBS with the Mazor Renaissance Guidance System and evaluate operative variables and stereotactic accuracy. METHODS: Retrospective data collection at a single institution was conducted for an initial 35 consecutive patients. Patient demographics and operative variables, including case times, microelectrode recording passes, and postoperative complications, were obtained by chart review. Implant accuracy was evaluated through measuring radial and vector (x, y) errors using the Mazor software. Pneumocephalus volumes were calculated using immediate postoperative T1-weighted MRI scans. RESULTS: Total operating room (245 ± 5.5 min) and procedural (179 ± 4.7) times were comparable with previous awake DBS literature. The radial error for center tract implants was 1.3 ± 0.1 mm, with smaller error in the first (1.1 ± 0.2) vs second (1.7 ± 0.3) implants of bilateral DBS (P = .048). Vector error analysis demonstrated larger shifts posteriorly for first implants and medially for second implants. Pneumocephalus volumes (12.4 ± 2.2 cm 3 ) were not associated with increased microelectrode recording passes, radial error, or complications. CONCLUSION: Frameless robotic-assisted DBS is a safe and efficient new technology that has been easily adopted into the workflow at our institution.

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

“…5,17-23 Four studies reported their use of a skull-mounted robot with optical array registration/navigation, with a target radial error of 1.12 ± 0.54 mm (n = 406 electrodes), operative time of 155.4 ± 36.5 minutes (n = 406), and total procedure time of 277.1 ± 38.2 minutes (n = 165). 7,24-26 Three studies (including this study) reported the use of a floor-mounted robot with a frameless transient fiducial array, with a target radial error of 0.84 ± 0.54 mm (n = 631 electrodes), operative time of 182.4 ± 47.8 minutes (n = 315), and total procedure time of 311.9 ± 63.0 min (n = 315). 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).…”

Accuracy and safety of deep brain stimulation assisted by a neurosurgical robot attachable to the operating table

“…Bunyaratavej et al [26] reported that the error was significantly larger for the second implant, usually in the antero-posterior direction. Liang et al [19] also reported error of the second implant (right side) was much larger than that of the first implant (left side) when using frameless robot system. The error might be a consequence of brain shift that results from cerebrospinal fluid (CSF) loss and pneumocephalus that occurs after surgery, especially after more manipulation of patients with macrostimulations [27,28].…”

“…In recent reports of errors achieved with other robot-assisted DBS, mean radial errors ranged from 0.6 to 1.7 mm and most studies comparing errors with the classic method showed better non-inferior outcomes in robot groups; the errors from other robot-based DBS surgeries are shown in Table 2 [12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”