Dashtkoohi Mohammad, Ashtari Sara, Delbari Pouria, Mehrabi Mohammad Mahdi, Karimi Amirmasoud, Kakoienejad Mohammad Mahdi, Khaboushan Alireza Soltani, Ohadi Mohammad Amin Dabbagh
Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran.
Department of Surgery, Alborz University of Medical Sciences, Alborz, Iran.
Neurosurg Rev. 2025 Mar 31;48(1):342. doi: 10.1007/s10143-025-03476-3.
Recent robotic-assisted surgical systems have shown promising efficiency and accuracy in brain surgeries. However, their application in deep brain stimulation (DBS) surgery remains limited.
Studies from the Embase, Scopus, and Pubmed databases were included using a modified search string, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We extracted technical aspects of robotic-assisted DBS (RA-DBS) surgery, patient characteristics, accuracy, safety, and overall clinical results. We applied a random effects model for analysis. Heterogeneity was evaluated using Cochran's Q test and the I statistic. Additionally, subgroup analysis was conducted for the type of anesthesia, and frame-based versus frameless procedures and using microelectrode recordings (MER). Quality appraisal was conducted using the Newcastle-Ottawa Scale.
The pooled mean radial error (RE) and Euclidean distance (3D-EE) in robotic surgeries were 1.04 mm (95% CI 0.93 to 1.15 mm) and 1.19 mm (95% CI: 0.94 - 1.45 mm). RA-DBS outcomes regarding RE were comparable to conventional stereotactic DBS (C-DBS) surgery (SMD: -0.56, 95% CI: -1.35 - 0.22, P-value: 0.16). Also, the difference in the rates of reported complications was insignificant (OR: 0.26, 95% CI: -0.64 - 1.15, P-value: 0.58). None of the frame-based or frameless (P-value: 0.36), the use of MER (P-value: 0.11), or the type of anesthesia (P-value: 0.27) showed significant differences. However, there was an insignificant lower RE trend in the studies that employed frame-based techniques, used general anesthesia, and did not utilize MER.
Our study shows an acceptable level of error associated with RA-DBS. We found that the accuracy and complication rates were comparable to C-DBS. Due to substantial heterogeneity in the pooled mean RE and 3D-EE, more studies with higher sample sizes are required to evaluate RA-DBS.
近期的机器人辅助手术系统在脑部手术中展现出了令人期待的效率和准确性。然而，它们在深部脑刺激（DBS）手术中的应用仍然有限。
按照系统评价与Meta分析的首选报告项目（PRISMA）指南，使用经过修改的检索词，纳入了来自Embase、Scopus和Pubmed数据库的研究。我们提取了机器人辅助DBS（RA-DBS）手术的技术方面、患者特征、准确性、安全性以及总体临床结果。我们应用随机效应模型进行分析。使用Cochran's Q检验和I统计量评估异质性。此外，针对麻醉类型、基于框架与无框架手术以及是否使用微电极记录（MER）进行了亚组分析。使用纽卡斯尔-渥太华量表进行质量评估。
机器人手术中的合并平均径向误差（RE）和欧几里得距离（3D-EE）分别为1.04毫米（95%可信区间0.93至1.15毫米）和1.19毫米（95%可信区间：0.94 - 1.45毫米）。RA-DBS在RE方面的结果与传统立体定向DBS（C-DBS）手术相当（标准化均值差：-0.56，95%可信区间：-1.35 - 0.22，P值：0.16）。此外，报告的并发症发生率差异不显著（比值比：0.26，95%可信区间：-0.64 - 1.15，P值：0.58）。基于框架或无框架（P值：0.36）、是否使用MER（P值：0.11）或麻醉类型（P值：0.27）均未显示出显著差异。然而，在采用基于框架技术、使用全身麻醉且未使用MER的研究中，RE有一个不显著的较低趋势。
我们的研究表明RA-DBS存在可接受水平的误差。我们发现其准确性和并发症发生率与C-DBS相当。由于合并平均RE和3D-EE存在显著异质性，需要更多样本量更大的研究来评估RA-DBS。
