1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia.
Acta Clin Croat. 2021 Jun;60(2):296-303. doi: 10.20471/acc.2021.60.02.17.
Robot-assisted brain tumor biopsy is becoming one of the most important innovative technologies in neurosurgical practice. The idea behind its engagement is to advance the safety and efficacy of the biopsy procedure, which is much in demand when planning the management of endocranial tumor pathology. Herein, we provide our earliest institutional experiences in utilizing this mesmerizing technology. Cranial robotic device was employed for stereotactic robot-assisted brain glioma biopsy in three consecutive patients from our series: an anaplastic isocitrate dehydrogenase (IDH) negative astrocytoma (WHO grade III) located in the right trigone region of the periventricular white matter; a low grade diffuse astrocytoma (WHO grade II) of bilateral thalamic region spreading into the right mesencephalic area; and an IDH-wildtype glioblastoma (WHO grade IV) of the right frontal lobe producing a contralateral midline shifting. Robot-assisted tumor biopsy was successfully performed to get tissue samples for histopathologic and immunohistochemical analysis. The adjacent tissue iatrogenic damage of the eloquent cortical areas was minimal, while the immediate postoperative recovery was satisfactory in all patients. In conclusion, considering the preliminary results of our early experiences, robot-assisted tumor biopsy was proven to be a feasible and accurate procedure when surgery for brain glioma was not an option. It may increase safety and precision, without expanding surgical time, being similarly effective when compared to standard stereotactic and manual biopsy. Using this method to provide accurate sampling for histopathologic and immunohistochemical analysis is a safe and easy way to determine management strategies and outcome of different types of brain glioma.
机器人辅助脑肿瘤活检正在成为神经外科实践中最重要的创新技术之一。其背后的理念是提高活检过程的安全性和有效性，这在规划颅内肿瘤病理管理时非常重要。在此，我们提供了我们最早在使用这项令人瞩目的技术方面的机构经验。在我们的连续三个患者中，使用颅机器人设备进行立体定向机器人辅助脑胶质瘤活检：一个位于侧脑室周围白质右三角区的间变性异柠檬酸脱氢酶（IDH）阴性星形细胞瘤（WHO 分级 III）；一个位于双侧丘脑区的低级别弥漫性星形细胞瘤（WHO 分级 II），扩散至右侧中脑区域；和一个 IDH 野生型胶质母细胞瘤（WHO 分级 IV）位于右侧额叶，导致对侧中线移位。成功进行了机器人辅助肿瘤活检，以获取组织样本进行组织病理学和免疫组织化学分析。在所有患者中，对语言皮质等邻近组织的医源性损伤最小，且术后即刻恢复令人满意。总之，考虑到我们早期经验的初步结果，当脑胶质瘤手术不是一种选择时，机器人辅助肿瘤活检被证明是一种可行且准确的方法。它可以提高安全性和精确度，而不会延长手术时间，与标准的立体定向和手动活检效果相当。使用这种方法对不同类型的脑胶质瘤进行准确的组织病理学和免疫组织化学分析是一种安全、简便的方法，可以确定不同类型脑胶质瘤的治疗策略和结果。
