Article
The Neuromate® robot: the in vivo application accuracy during frame based stereotactic implantations of electrodes for deep brain stimulation (DBS)
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Authors
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Daniel von Langsdorff
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Nice, France
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Marco Sgambati
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Nice, France; Dipartimento di neurochirurgia Seconda università degli Studi di Napoli, Italia
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Philippe Paquis
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Nice, France
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Denys Fontaine
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Nice, France; Image-Guided Clinical Neuroscience and Connectomics, Université d'Auvergne Clermont, Clermont-Ferrand, France
| Published: | June 2, 2015 |
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Outline
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Objective: The neurosurgical robot Neuromate® is now routinely employed for the implantation of electrodes in DBS procedures. The in vitro application accuracy has been evaluated, also the accuracy in several in vivo applications in patients but not particularly for the electrode placement in DBS.
The aim was to determine the in vivo application accuracy of the Neuromate® robot under operating conditions during frame-based electrode implantations for DBS procedures. For this evaluation the control device should be independent from the robot.
Method: After placement of the Fischer® frame on the patient and MR imaging the target was determined on the robots' dedicated planning software Voxim® with calculation of the stereotactic coordinates.
After introduction of the tube guide the stereotactic coordinates of its tip were measured intra-operatively through orthogonal x-rays employing the Stereoplan® localizer system, a device independent from the robot. We calculated the Euclidian distance between the planning target point and the tip of the tube guide based on their respective stereotactic coordinates.
First the procedure was experimented in vitro, the stereotactic frame fixed on the robots' ring-holder without patient. We checked 21 points widely distributed in the stereotactic space.
The in vivo accuracy was then evaluated for 44 basal ganglia targets in 25 consecutive patients operated by DBS for movement disorders.
Results: In vitro the mean application accuracy A (SD) was A = 0,44 mm (0,23 mm).
Mean dx = 0,24 mm (0,19), mean dy = 0,26 mm (0,20), mean dz = 0,17 mm (0,13). The maximal localization error was 1,0 mm.
In vivo the mean application accuracy A (SD) was A = 0,87 mm (0,28 mm).
Mean dx = 0,35 mm (0,30), mean dy = 0,37 mm (0,29), mean dz = 0,57 mm (0,29).
The maximal error was 1,55 mm.
Conclusions: The in vivo application accuracy of the neurosurgical robot Neuromate® in frame-based DBS procedures was determined with a value below one millimeter, controlled by a system independent from the robot. This accuracy is in the range of the accuracy required for DBS procedures and corresponds to the experience of the accuracy of stereotactic frame arms in the literature.
