Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Università degli Studi, Milan, Italy.
Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia.
Oper Neurosurg (Hagerstown). 2019 Oct 1;17(4):403-412. doi: 10.1093/ons/opy411.
Robotic technologies have been used in the neurosurgical operating rooms for the last 30 yr. They have been adopted for several stereotactic applications and, particularly, image-guided biopsy of intracranial lesions which are not amenable for open surgical resection.
To assess feasibility, safety, accuracy, and diagnostic yield of robot-assisted frameless stereotactic brain biopsy with a recently introduced miniaturized device (iSYS1; Interventional Systems Medizintechnik GmbH, Kitzbühel, Austria), fixed to the Mayfield headholder by a jointed arm.
Clinical and surgical data of all patients undergoing frameless stereotactic biopsies using the iSYS1 robotized system from October 2016 to December 2017 have been prospectively collected and analyzed. Facial surface registration has been adopted for optical neuronavigation.
Thirty-nine patients were included in the study. Neither mortality nor morbidity related to the surgical procedure performed with the robot was recorded. Diagnostic tissue samples were obtained in 38 out of 39 procedures (diagnostic yield per procedure was 97.4%). All patients received a definitive histological diagnosis. Mean target error was 1.06 mm (median 1 mm, range 0.1-4 mm).
The frameless robotic iSYS1-assisted biopsy technique was determined to be feasible, safe, and accurate procedure; moreover, the diagnostic yield was high. The surface matching registration method with computed tomography as the reference image set did not negatively affect the accuracy of the procedure.
机器人技术在神经外科手术室中已经使用了 30 年。它们已经被用于几种立体定向应用，特别是对于不能进行开放性手术切除的颅内病变进行图像引导活检。
评估最近引入的小型设备（iSYS1；Interventional Systems Medizintechnik GmbH，基茨比厄尔，奥地利）与关节臂固定在 Mayfield 头架上的机器人辅助无框架立体定向脑活检的可行性、安全性、准确性和诊断率。
对 2016 年 10 月至 2017 年 12 月期间使用 iSYS1 机器人系统进行无框架立体定向活检的所有患者的临床和手术数据进行了前瞻性收集和分析。采用面部表面配准进行光学神经导航。
39 例患者纳入研究。未记录到与机器人辅助手术相关的死亡率或发病率。在 39 例手术中有 38 例获得了诊断性组织样本（每例手术的诊断率为 97.4%）。所有患者均获得明确的组织学诊断。平均目标误差为 1.06 毫米（中位数 1 毫米，范围 0.1-4 毫米）。
无框架机器人 iSYS1 辅助活检技术是一种可行、安全、准确的操作方法；此外，诊断率较高。以计算机断层扫描为参考图像集的表面匹配注册方法不会对手术的准确性产生负面影响。
