Frameless stereotactic brain biopsy has become an established procedure in many neurosurgical centers worldwide. Robotic modifications of image-guided frameless stereotaxy hold promise for making these procedures safer, more effective, and more efficient. The authors hypothesized that robotic brain biopsy is a safe, accurate procedure, with a high diagnostic yield and a safety profile comparable to other stereotactic biopsy methods.
This retrospective study included 41 patients undergoing frameless stereotactic brain biopsy of lesions (mean size 2.9 cm) for diagnostic purposes. All patients underwent image-guided, robotic biopsy in which the SurgiScope system was used in conjunction with scalp fiducial markers and a preoperatively selected target and trajectory. Forty-five procedures, with 50 supratentorial targets selected, were performed.
The mean operative time was 44.6 minutes for the robotic biopsy procedures. This decreased over the second half of the study by 37%, from 54.7 to 34.5 minutes (p < 0.025). The diagnostic yield was 97.8% per procedure, with a second procedure being diagnostic in the single nondiagnostic case. Complications included one transient worsening of a preexisting deficit (2%) and another deficit that was permanent (2%). There were no infections.
Robotic biopsy involving a preselected target and trajectory is safe, accurate, efficient, and comparable to other procedures employing either frame-based stereotaxy or frameless, nonrobotic stereotaxy. It permits biopsy in all patients, including those with small target lesions. Robotic biopsy planning facilitates careful preoperative study and optimization of needle trajectory to avoid sulcal vessels, bridging veins, and ventricular penetration.
Abbreviations used in this paper:AA = anaplastic astrocytoma; GBM = glioblastoma multiforme.
BenabidALCinquinPLavalleSLe BasJFDemongeotJde RougemontJ: Computer-driven robot for stereotactic surgery connected to CT scan and magnetic resonance imaging. Technological design and preliminary results. Appl Neurophysiol50:153–1541987
BernaysRLKolliasSSKhanNBrandnerSMeierSYonekawaY: Histological yield, complications, and technological considerations in 114 consecutive frameless stereotactic biopsy procedures aided by open intraoperative magnetic resonance imaging. J Neurosurg97:354–3622002
BjartmarzHRehncronaS: Comparison of accuracy and precision between frame-based and frameless stereotactic navigation for deep brain stimulation electrode implantation. Stereotact Funct Neurosurg85:235–2422007
LiQHZamoranoLPandyaAPerezRGongJDiazF: The application accuracy of the NeuroMate robot—A quantitative comparison with frameless and frame-based surgical localization systems. Comput Aided Surg7:90–982002
MoritaASoraSMitsuishiMWarisawaSSurumanKAsaiD: Microsurgical robotic system for the deep surgical field: development of a prototype and feasibility studies in animal and cadaveric models. J Neurosurg103:320–3272005
SmithJSQuiñones-HinojosaABarbaroNMMcDermottMW: Frame-based stereotactic biopsy remains an important diagnostic tool with distinct advantages over frameless stereotactic biopsy. J Neurooncol73:173–1792005
WillemsPWNoordmansHJBerkelbach van der SprenkelJWViergeverMATullekenCA: An MKM-mounted instrument holder for frameless point-stereotactic procedures: a phantom-based accuracy evaluation. J Neurosurg95:1067–10742001
WillemsPWNoordmansHJRamosLMTaphoornMJBerkelbach van der SprenkelJWViergeverMA: Clinical evaluation of stereotactic brain biopsies with an MKM-mounted instrument holder. Acta Neurochir (Wien)145:889–8972003