gms | German Medical Science

Objective: Frame-based stereotaxy is the gold standard for biopsies or electrode implantations in precarious brain regions. However, the accessibility of the temporal lobe for frame-based stereotactic procedures is constricted by the dimensions and mounting of the head ring resulting in compromises in trajectory planning and surgical approach to the target. Novel robot-guided stereotaxy systems could help to overcome these constraints.

Method: Five consecutive patients (63 ± 21 years [mean ± SD], range: 27 - 80 years, 1 female) with temporal lesions (2x astrocytoma WHO° II, 1x astrocytoma WHO°III, 2x astrocytoma WHO°IV) underwent a robot-guided biopsy with a head-mounted device. Feasibility of this new robotic device in temporal lobe biopsies and the range of possible trajectories were evaluated. Diagnostic yield and perioperative complications were documented.

Results: In all cases a safe trajectory to the lesion could be assigned. In two cases a ventro-dorsal direction of the trajectory was preferred. Postoperative CT scans confirmed accurate biopsy. There were no perioperative complications such as bleedings or postoperative neurological deficits. Histological diagnosis was confirmed in all except of one patient due to undersized tissue sample.

Conclusions: The new head-mounted device was applied successfully in temporal lobe biopsies. The presented technology increases neurosurgeon’s freedom in entry point selection and trajectory planning, thereby augmenting the accessibility of the temporal lobe for biopsies or electrode implantations.