Robot-Assisted Deep Brain Stimulation: High Accuracy and Streamlined Workflow

Abstract

BACKGROUND: A number of stereotactic platforms are available for performing deep brain stimulation (DBS) lead implantation. Robot-assisted stereotaxy has emerged more recently demonstrating comparable accuracy and shorter operating room times compared with conventional frame-based systems. OBJECTIVE: To compare the accuracy of our streamlined robotic DBS workflow with data in the literature from frame-based and frameless systems. METHODS: We retrospectively reviewed 126 consecutive DBS lead placement procedures using a robotic stereotactic platform. Indications included Parkinson disease (n = 94), essential tremor (n = 21), obsessive compulsive disorder (n = 7), and dystonia (n = 4). Procedures were performed using a stereotactic frame for fixation and the frame pins as skull fiducials for robot registration. We used intraoperative fluoroscopic computed tomography for registration and postplacement verification. RESULTS: The mean radial error for the target point was 1.06 mm (SD: 0.55 mm, range 0.04-2.80 mm) on intraoperative fluoroscopic computed tomography. The mean operative time for an asleep, bilateral implant without implantable pulse generator placement was 238 minutes (SD: 52 minutes), and skin-to-skin procedure time was 116 minutes (SD: 42 minutes). CONCLUSION: We describe a streamlined workflow for DBS lead placement using robotassisted stereotaxy with a comparable accuracy profile. Obviating the need for checking and switching coordinates, as is standard for frame-based DBS, also reduces the chance for human error and facilitates training.

Application of the robot-assisted implantation in deep brain stimulation

“…In addition, Giridharan et al (2022) used robotic stereotactic platform of ROSA for DBS surgery under general anesthesia, and used intraoperative fluoroscopic computed tomography for registration and postplacement verification. The robot used in our study can perform DBS surgery under local anesthesia, during which MER electrophysiological monitoring was used to assist in locating nuclear.…”

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

“…The adoption of this tool can be attributed to the increased efficiency and precision associated with robotics. 7,17,18,24 Furthermore, advances in imaging technology and resolution have allowed for accurate direct targeting in asleep DBS. Here, we detail our technique for robotic stereotactic implantation of DBS electrodes in asleep patients in a less invasive manner.…”

“…Nine studies reported data on this method, with a target radial error of 0.91 ± 0.38 mm (n = 819 electrodes), operative time of 109.1 ± 50.5 minutes (n = 659), and total procedure time of 249.2 ± 72.3 minutes (n = 265). 5,[17][18][19][20][21][22][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][25][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).…”

“…4,8 The most noticeable contribution of robotic assistance is its ability to automatically compute and execute planned trajectories, thus removing the inherent human error associated with manually setting stereotactic frame coordinates. 4,8,17 The accuracy of the robot can also be checked preoperatively and intraoperatively using fiducial markers. Despite the initial learning curve attributed to introduction of robotic systems, this automation can significantly improve operative efficiency.…”

“…Several studies directly compared frame-based and robot-assisted DBS and demonstrated shorter operative times with robot-assisted DBS. 7,17,24 Improved efficiency, coupled with smaller 3.2-mm craniostomies, can decrease postdurotomy time, which decreases cerebrospinal fluid leak, pneumocephalus, and brain shift, leading to improved overall accuracy and quicker postoperative recovery. 8 Furthermore, robotic assistance can be used for any DBS technique: awake or asleep, with or without MER.…”