Terrier Laura, Gilard Vianney, Marguet Florent, Fontanilles Maxime, Derrey Stéphane
Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France.
Department of Pathology, Rouen University Hospital, 76000, Rouen, France.
Acta Neurochir (Wien). 2019 Mar;161(3):545-552. doi: 10.1007/s00701-019-03808-5. Epub 2019 Jan 24.
Frameless stereotactic biopsies, particularly robot-assisted procedures are increasing in neurosurgery centers. Results of these procedures should be at least equal to or greater than frame-based reference procedure. Evaluate robot-assisted technology is necessary in particular, when a team has chosen to switch from one to another method.
The objective of our prospective work was (i) to evaluate the success rate of contributive robotic-assisted biopsy in 60 patients, to report the morbidity and mortality associated with the procedure and (ii) to compare it with literature data.
We performed a prospective and descriptive study including 60 consecutive patients having had robotic-assisted stereotactic biopsy at the Rouen University Hospital, France. All patients had presurgical imaging before the procedure included Magnetic Resonance Imaging merged with Computed Tomography scan acquisition. Registration was mostly performed with a touch-free laser (57/60). A control Computed Tomography scan was always realized at day 0 or day 1 after surgery. Data collected were success rate, bleeding, clinical worsening, infection, and mortality.
All the biopsies were considered as contributive and lead to the final diagnosis. In 41/60 patients (68%), the lesion was glial. Six in 60 patients (10%) had visible bleeding without clinical worsening related, 5/60 patients (8.5%) showed clinical impairment following surgery, which was permanent in 2 patients, and 1/60 patient presented generalized seizures. We did not report any infection and mortality.
Robot-assisted frameless surgery is efficient and provides a reasonable alternative to frame-based procedure. The operating time can be reduced, without increasing morbidity and mortality rates.
在神经外科中心，无框架立体定向活检，尤其是机器人辅助手术的应用日益增多。这些手术的结果应至少等同于或优于基于框架的参考手术。特别是当一个团队选择从一种方法转换到另一种方法时，评估机器人辅助技术是必要的。
我们前瞻性研究的目的是（i）评估60例患者中机器人辅助活检的成功率，报告与该手术相关的发病率和死亡率，以及（ii）将其与文献数据进行比较。
我们进行了一项前瞻性描述性研究，纳入了法国鲁昂大学医院连续60例行机器人辅助立体定向活检的患者。所有患者在手术前均进行了包括磁共振成像与计算机断层扫描合并采集在内的术前影像学检查。配准大多采用非接触式激光（57/60）。术后第0天或第1天总是进行对照计算机断层扫描。收集的数据包括成功率、出血情况、临床恶化情况、感染情况和死亡率。
所有活检均被认为有助于最终诊断。60例患者中有41例（68%）病变为神经胶质细胞病变。60例患者中有6例（10%）有可见出血但无相关临床恶化，60例患者中有5例（8.5%）术后出现临床损伤，其中2例为永久性损伤，60例患者中有1例出现全身性癫痫发作。我们未报告任何感染和死亡病例。
机器人辅助无框架手术是有效的，为基于框架的手术提供了合理的替代方案。手术时间可以缩短，而不增加发病率和死亡率。
