J Neurosurg Pediatr. 2023 Dec 22;33(3):207-213. doi: 10.3171/2023.10.PEDS23275. Print 2024 Mar 1.
OBJECTIVE: The Neurolocate module is a 3D frameless patient registration module that is designed for use with the Neuromate stereotactic robot. Long-term electrical stimulation of the globus pallidus internus (GPi) and subthalamic nucleus (STN) via deep brain electrode implantation is particularly successful in a select group of movement disorders in pediatric patients. This study aimed to review the targeting accuracy of deep brain stimulation (DBS) electrode implantation in a single center, comparing standard frame-based techniques to the frameless Neurolocate module. METHODS: Twenty-four pediatric patients underwent implantation of bilateral DBS electrodes under general anesthesia during the period of August 2018-August 2022. All patients underwent robot-assisted stereotactic implantation of DBS electrodes using an intraoperative O-arm 3D scanner to confirm the final electrode position. These coordinates were compared with the planned entry and target, with attention to depth, radial, directional, and absolute errors, in addition to Euclidean distance (ED). The primary outcome evaluated the accuracy and safety of the Neurolocate frameless technology compared with standard frame-based techniques. RESULTS: Of the 24 bilateral DBS electrode implantations performed, 62.5% used Neurolocate technology: 87.5% were delivered to the GPi and the remaining 12.5% to the STN. The mean patient age was 11.0 (range 4-18) years and 70.8% were male. The median absolute errors in x-, y-, and z-axes were 0.35, 0.75, and 0.9 mm, respectively, using the Neurolocate module compared with 0.30, 0.95, and 1.1 mm using the standard frame-based technique. The median ED from the planned target to the actual electrode position with the Neurolocate module was 1.28 mm versus 1.69 mm using standard frame-based techniques. No major perioperative complications occurred. CONCLUSIONS: Stereotactic robot-assisted DBS implantation with the frameless Neurolocate module is safe for use in the pediatric population, showing good surgical accuracy and no inferiority to standard frame-based techniques. The Neurolocate module for robotic DBS surgery has the potential to improve surgical targeting accuracy, surgical time, patient comfort, and safety.
目的：Neurolocate 模块是一种无框架患者注册模块，专为 Neuromate 立体定向机器人设计。通过深部脑电极植入术对苍白球内（GPi）和丘脑底核（STN）进行长期电刺激，在小儿运动障碍患者中尤其成功。本研究旨在回顾单中心深部脑刺激（DBS）电极植入的靶向准确性，比较标准框架技术与无框架 Neurolocate 模块。
方法：2018 年 8 月至 2022 年 8 月期间，24 例小儿患者在全身麻醉下接受双侧 DBS 电极植入。所有患者均在术中使用 O 臂 3D 扫描仪进行机器人辅助立体定向 DBS 电极植入，以确认最终电极位置。这些坐标与计划的进入点和目标点进行比较，注意深度、半径、方向和绝对误差，以及欧几里得距离（ED）。主要结果是评估 Neurolocate 无框架技术与标准框架技术相比的准确性和安全性。
结果：在 24 例双侧 DBS 电极植入中，62.5%使用了 Neurolocate 技术：87.5%植入 GPi，其余 12.5%植入 STN。患者平均年龄为 11.0 岁（范围 4-18 岁），70.8%为男性。使用 Neurolocate 模块时，x、y 和 z 轴的平均绝对误差分别为 0.35、0.75 和 0.9 毫米，而使用标准框架技术时分别为 0.30、0.95 和 1.1 毫米。使用 Neurolocate 模块时，从计划靶标到实际电极位置的中位 ED 为 1.28 毫米，而使用标准框架技术时为 1.69 毫米。无重大围手术期并发症发生。
结论：立体定向机器人辅助 DBS 植入术使用无框架 Neurolocate 模块在小儿人群中是安全的，具有良好的手术准确性，并不逊于标准框架技术。无框架机器人 DBS 手术的 Neurolocate 模块有可能提高手术靶向准确性、手术时间、患者舒适度和安全性。
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