Robotic-Assisted Stereotaxy for Deep Brain Stimulation Lead Implantation in Awake Patients
- 6 March 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Operative Neurosurgery
- Vol. 19 (4), 444-452
- https://doi.org/10.1093/ons/opaa029
Abstract
Robotic-assisted stereotaxy has been increasingly adopted for lead implantation in stereoelectroencephalography based on its efficiency, accuracy, and precision. Despite initially being developed for use in deep brain stimulation (DBS) surgery, adoption for this indication has not been widespread. To describe a recent robotic-assisted stereotaxy experience and workflow for DBS lead implantation in awake patients with and without microelectrode recording (MER), including considerations for intraoperative research using electrocorticography (ECoG). A retrospective review of 20 consecutive patients who underwent simultaneous bilateral DBS lead implantation using robotic-assisted stereotaxy was performed. Radial error was determined by comparing the preoperative target with the DBS lead position in the targeting plane on postoperative computed tomography. Information regarding any postoperative complications was obtained by chart review. A novel method for robot coregistration was developed. We describe a standard workflow that allows for MER and/or ECoG research, and a streamlined workflow for cases in which MER is not required. The overall radial error for lead placement across all 20 patients was 1.14 ± 0.11 mm. A significant difference (P = .006) existed between the radial error of the first 10 patients (1.46 ± 0.19 mm) as compared with the second 10 patients (0.86 ± 0.09 mm). No complications were encountered. Robotic-assisted stereotaxy has the potential to increase precision and reduce human error, compared to traditional frame-based DBS surgery, without negatively impacting patient safety or the ability to perform awake neurophysiology research.Keywords
This publication has 31 references indexed in Scilit:
- Stereoelectroencephalography in the “difficult to localize” refractory focal epilepsy: Early experience from a North American epilepsy centerEpilepsia, 2012
- Robotic implantation of deep brain stimulation leads, assisted by intra-operative, flat-panel CTActa Neurochirurgica, 2012
- Oscillations in sensorimotor cortex in movement disorders: an electrocorticography studyBrain, 2012
- Surgical Repositioning of Misplaced Subthalamic Electrodes in Parkinson’s Disease: Location of Effective and Ineffective LeadsStereotactic and Functional Neurosurgery, 2009
- Robotic Neurological Surgery Applications: Accuracy and Consistency or Pure Fantasy?Stereotactic and Functional Neurosurgery, 2009
- Validation of the PathFinder™ neurosurgical robot using a phantomInternational Journal of Medical Robotics and Computer Assisted Surgery, 2007
- Image-guided Robotic RadiosurgeryNeurosurgery, 1999
- Computer- and Robot-assisted Resection of Thalamic Astrocytomas in ChildrenNeurosurgery, 1991
- Computer- and robot-assisted resection of thalamic astrocytomas in childrenNeurosurgery, 1991
- Computer-Driven Robot for Stereotactic Surgery Connected to CT Scan and Magnetic Resonance ImagingStereotactic and Functional Neurosurgery, 1987