Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Faculdade da Saúde e Ecologia Humana, Belo Horizonte, Brazil.
Neurosurg Rev. 2024 Nov 30;47(1):880. doi: 10.1007/s10143-024-03121-5.
Stereotactic biopsies are essential for obtaining accurate histopathological analysis to guide treatment decisions for deep-seated brain lesions. Manually guided methods, while commonly used and highly precise, can be limited by potential inaccuracies and insufficient tissue sampling. The emerging robot-assisted (RA) techniques offer enhanced precision and could address these limitations for improved accuracy. We aimed to compare safety and effectiveness of RA stereotactic biopsies to traditional techniques. We conducted a systematic search of PubMed, Embase, and Web of Science using terms related to robotic biopsies and intracranial lesions. Eligible studies compared robot-assisted procedures to traditional techniques. Data extracted included diagnostic yield, complication rates, and accuracy. Quality assessment of studies was performed with the ROBINS-I tool, and a random-effects model meta-analysis was performed. Five studies were included, encompassing 913 patients (robot-assisted n = 434, traditional n = 479). Robot-assisted biopsies demonstrated higher diagnostic yield (OR 2.06, 95% CI [1.01,4.21], p = 0.04), and improved trajectory accuracy, with entry point error (EPE) reduced by 0.42 mm (95% CI [-0.59,-0.26], p < 0.001) and target point error (TPE) reduced by 0.93 mm (95% CI [-1.80,-0.06], p < 0.01). There were no significant differences in the incidence of complications or operative time. RA stereotactic biopsies may improve diagnostic yield and accuracy in targeting intracranial lesions without increasing complication rates or operative time. The limited number of studies and potential biases suggest a need for further high-quality, prospective research to ascertain these findings.
立体定向活检对于获取准确的组织病理学分析以指导深部脑病变的治疗决策至关重要。手动引导方法虽然常用且高度精确，但可能存在潜在的不准确性和组织采样不足的限制。新兴的机器人辅助 (RA) 技术提供了更高的精度，并可以解决这些限制，以提高准确性。我们旨在比较 RA 立体定向活检与传统技术的安全性和有效性。我们使用与机器人活检和颅内病变相关的术语对 PubMed、Embase 和 Web of Science 进行了系统搜索。符合条件的研究比较了机器人辅助程序与传统技术。提取的数据包括诊断率、并发症发生率和准确性。使用 ROBINS-I 工具对研究进行质量评估，并进行了随机效应模型荟萃分析。共纳入了 5 项研究，包括 913 名患者（机器人辅助 n=434，传统 n=479）。机器人辅助活检显示出更高的诊断率（OR 2.06，95%CI [1.01，4.21]，p=0.04），并且轨迹准确性提高，入口点误差 (EPE) 降低了 0.42mm（95%CI [-0.59，-0.26]，p<0.001），目标点误差 (TPE) 降低了 0.93mm（95%CI [-1.80，-0.06]，p<0.01）。并发症发生率或手术时间无显著差异。RA 立体定向活检可能会提高颅内病变的诊断率和准确性，而不会增加并发症发生率或手术时间。研究数量有限且存在潜在偏倚，表明需要进一步进行高质量、前瞻性研究来确定这些发现。
