Neudorfer Clemens, Hunsche Stefan, Hellmich Martin, El Majdoub Faycal, Maarouf Mohammad
Department for Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany.
Department for Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany,
Stereotact Funct Neurosurg. 2018;96(5):327-334. doi: 10.1159/000494736. Epub 2018 Nov 27.
BACKGROUND/AIMS: Technological advancements had a serious impact on the evolution of robotic systems in stereotactic neurosurgery over the last three decades and may turn robot-assisted stereotactic neurosurgery into a sophisticated alternative to purely mechanical guiding devices. OBJECTIVES: To compare robot-assisted and conventional frame-based deep brain stimulation (DBS) surgery with regard to accuracy, precision, reliability, duration of surgery, intraoperative imaging quality, safety and maintenance using a standardized setup. METHODS: Retrospective evaluation of 80 consecutive patients was performed who underwent DBS surgery using either a frame-based mechanical stereotactic guiding device (n = 40) or a stereotactic robot (ROSA Brain, MedTech, Montpellier, France) (n = 40). RESULTS: The mean accuracy of robot-assisted and conventional lead implantation was 0.76 mm (SD: 0.37 mm, range: 0.17-1.52 mm) and 1.11 mm (SD: 0.59 mm, range: 0.10-2.90 mm), respectively. We observed a statistically significant difference in accuracy (p < 0.001) when comparing lateral deviations between both modalities. Furthermore, a statistical significance was observed when investigating the proportion of values exceeding 2.00 mm between both groups (p = 0.013). In 8.75% (n = 7) of conventionally implanted leads, lateral deviations were greater than 2.0 mm. With a maximum value of 1.52 mm, this threshold was never reached during robot-guided DBS. The mean duration of DBS surgery could be reduced significantly (p < 0.001) when comparing robot-guided DBS (mean: 325.1 ± 81.6 min) to conventional lead implantation (mean: 394.8 ± 66.6 min). CONCLUSIONS: Robot-assisted DBS was shown to be superior to conventional lead implantation with respect to accuracy, precision and operation time. Improved quality control, continuous intraoperative monitoring and less manual adjustment likely contribute to the robotic system's reliability allowing high accuracy during lead implantation despite limited experience. Hence, robot-assisted lead implantation can be considered an appropriate and reliable alternative to purely mechanical devices.
背景/目的：在过去三十年中，技术进步对立体定向神经外科机器人系统的发展产生了重大影响，并可能使机器人辅助立体定向神经外科手术成为纯机械导向装置的一种复杂替代方案。 目的：使用标准化设置，比较机器人辅助和传统框架式脑深部电刺激（DBS）手术在准确性、精确性、可靠性、手术持续时间、术中成像质量、安全性和维护方面的差异。 方法：对80例连续接受DBS手术的患者进行回顾性评估，其中40例使用基于框架的机械立体定向导向装置，40例使用立体定向机器人（ROSA Brain，MedTech，法国蒙彼利埃）。 结果：机器人辅助和传统电极植入的平均准确性分别为0.76毫米（标准差：0.37毫米，范围：0.17 - 1.52毫米）和1.11毫米（标准差：0.59毫米，范围：0.10 - 2.90毫米）。比较两种方式的横向偏差时，我们观察到准确性存在统计学显著差异（p < 0.001）。此外，在研究两组中超过2.00毫米的值的比例时也观察到统计学显著性（p = 0.013）。在8.75%（n = 7）的传统植入电极中，横向偏差大于2.0毫米。在机器人引导的DBS手术中，最大值为1.52毫米，从未达到该阈值。将机器人引导的DBS手术（平均：325.1 ± 81.6分钟）与传统电极植入（平均：394.8 ± 66.6分钟）进行比较时，DBS手术的平均持续时间可显著缩短（p < 0.001）。 结论：机器人辅助DBS在准确性、精确性和手术时间方面优于传统电极植入。改进的质量控制、术中持续监测和更少的手动调整可能有助于机器人系统的可靠性，尽管经验有限，但在电极植入过程中仍能实现高精度。因此，机器人辅助电极植入可被视为纯机械设备的一种合适且可靠的替代方案。
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