Porto Junior Silvio, Meira Davi Amorim, da Cunha Beatriz Lopes Bernardo, Fontes Jefferson Heber Marques, Pustilnik Hugo Nunes, Medrado Nunes Gabriel Souza, Cerqueira Gabriel Araújo, Vassoler Maria Eduarda Messias, Monteiro Philippe Quadros, da Silva da Paz Matheus Gomes, Alcântara Tancredo, Carlos Dourado Jules, de Avellar Leonardo Miranda
Bahiana School of Medicine and Public Health, Dom João VI Avenue, 275, Brotas, Salvador, Bahia, Brazil.
University of Bahia State , Silveira Martins Street, 2555, Cabula, Salvador, 2555, Bahia, Brazil.
Neurosurg Rev. 2024 Dec 4;47(1):886. doi: 10.1007/s10143-024-03122-4.
Intracranial lesions often require tissue diagnosis through stereotactic biopsies. Originating in the 1970s, this technique has progressed, but limitations and risks persist. Recently, robot-assisted techniques have made strides, providing the potential for safer and more precise procedures. This study assesses the effectiveness and safety of robot-assisted brain biopsies.
Following Cochrane and PRISMA guidelines, PubMed, Embase, and Web of Science were searched for publications up to July 2024. Outcomes assessed included neurological deficits, hemorrhage, mortality, target point error, operative time, and length of stay. Data extraction and bias assessment were conducted using standardized methods, and statistical analysis was performed using R software.
In this meta-analysis, 27 papers were included, involving 2605 patients. The gender distribution was 1448 males to 1141 females. The mean error in millimeters for the entry point error was 1.04 (95%CI: 0.72-1.37), while the target point error was 1.08 (95%CI: 0.49-1.66). The mean operative time was 52.45 min (95%CI: 37.83-67.07). Diagnostic yield had an estimated rate of 98% (95%CI: 97-98%; I²=31%). The length of hospital stay was 4.64 days (95%CI: 3.13, 6.14), from admission to discharge. The postoperative hemorrhage had an estimated risk of 6% (95%CI: 4-9%; I²=71%), while for transient neurological deficits, it was 4% (95%CI: 2-6%; I²=60%). Finally, the death related to the procedure was found to have an estimated risk of 0% (95%CI: 0-0%; I²=0%).
Our study found that the diagnostic yield of stereotactic brain biopsy, especially with robotic assistance, has proven to be highly effective. Robot-assisted biopsies also seems to reduce operative times and demonstrate high precision with low entry point error and target point error. Additionally, complication rates appear to be relatively low, and the average hospital stay is favorably short, underscoring the advantages of robotic assistance in stereotactic brain biopsy procedures.
颅内病变通常需要通过立体定向活检进行组织诊断。这项技术起源于20世纪70年代，虽有进展，但局限性和风险依然存在。近年来，机器人辅助技术取得了长足进步，为更安全、精确的手术提供了可能。本研究评估了机器人辅助脑活检的有效性和安全性。
按照Cochrane和PRISMA指南，检索了截至2024年7月PubMed、Embase和Web of Science上的相关出版物。评估的结果包括神经功能缺损、出血、死亡率、靶点误差、手术时间和住院时间。采用标准化方法进行数据提取和偏倚评估，并使用R软件进行统计分析。
本荟萃分析纳入了27篇论文，涉及2605例患者。性别分布为男性1448例，女性1141例。进针点误差的平均毫米数为1.04（95%CI：0.72 - 1.37），靶点误差为1.08（95%CI：0.49 - 1.66）。平均手术时间为52.45分钟（95%CI：37.83 - 67.07）。诊断成功率估计为98%（95%CI：97 - 98%；I² = 31%）。住院时间为4.64天（95%CI：3.13，6.14），从入院到出院。术后出血的估计风险为6%（95%CI：4 - 9%；I² = 71%），短暂性神经功能缺损的风险为4%（95%CI：2 - 6%；I² = 60%）。最后，发现与手术相关的死亡估计风险为0%（95%CI：0 - 0%；I² = 0%）。
我们的研究发现，立体定向脑活检，尤其是在机器人辅助下，诊断成功率已被证明非常高。机器人辅助活检似乎还能缩短手术时间，且进针点误差和靶点误差小，精度高。此外，并发症发生率似乎相对较低，平均住院时间较短，凸显了机器人辅助在立体定向脑活检手术中的优势。
