Article
The advantage of a surgical robot (ROSA, Medtech) for neurosurgery in the field of stereo electroencephalography (SEEG), brain tumor surgery (biopsy), deep brain stimulation (DBS) and neuro-endoscopy (NE)
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Authors
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Manfred Kudernatsch
- Abteilung für Neurochirurgie und Epilepsiechirurgie, Schön Klinik Vogtareuth
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Mirjam Fuchs
- Abteilung für Neurochirurgie und Epilepsiechirurgie, Schön Klinik Vogtareuth
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Tom Pieper
- Abteilung für Neuropädiatrie, Schön Klinik Vogtareuth
| Published: | June 2, 2015 |
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Outline
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Objective: Stereotaxy and neuro-navigation are standard procedures to implant electrodes (SEEG, DBS), to perform brain biopsies and guide an endoscope. Robotics is an innovative technology which is gaining ground in neurosurgery. The use of a surgical robot can support or even replace standard neurosurgical procedures in different surgical techniques.
Method: The neurosurgical robot ROSA (Medtech) was initially established for the implantation of multiple depth electrodes (SEEG) in the context of invasive diagnostics in our clinic. The trajectory planning was based on MRI data. The implantation is conducted stereotactically and with the help of a robot. The accuracy of this method was determined through altogether 350 implanted depth electrodes based on a postoperative MRI. With identical robot equipment, the implementation of brain biopsies, DBS and cranial endoscopy is possible as either a stereotactic or frameless procedure using the available technologies (stereotactic frame, micro-drive, neuro-endoscopes).
Results: Since 2011, more than 40 neurosurgical procedures were robot assisted. Most of them were SEEGs with an implantation of 350 depth electrodes in 25 cases. For this number of electrodes, an accuracy of 0.6 mm at the entry point was determined. With an average implantation time of 8 min/electrode, this method reduces the operating time compared with a pure stereotactic implantation significantly.
This accuracy and time efficiency can also be used for DBS and brain biopsies. Biopsies (stereotactic or frameless – depending on the indication) are additionally carried out with a minimal invasive approach (4 mm drill hole). In NE the robot assists by controlled and supportive endoscope guidance.
Conclusions: Robot assisted neurosurgical procedures are precise and safe in certain fields of neurosurgery. The establishment of this technology was possible within daily routine. What makes this method stand out is the reduction in operating time, process optimization, patient safety and its extremely high accuracy.
