Artikel
Experience with with a novel miniature robotic guidance device in stereotactic neurosurgical procedures
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Autoren
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Stefan Wolfsberger
- Medizinische Universität Wien, Abteilung für Neurochirurgie, Wien, Österreich
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Georgi Minchev
- Medizinische Universität Wien, Abteilung für Neurochirurgie, Wien, Österreich
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Gernot Kronreif
- Austrian Center of Medical Innovation and Technology – ACMIT, Wien, Österreich
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Georg Widhalm
- Medizinische Universität Wien, Abteilung für Neurochirurgie, Wien, Österreich
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Aygül Mert
- Medizinische Universität Wien, Abteilung für Neurochirurgie, Wien, Österreich
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Barbara Kiesel
- Medizinische Universität Wien, Abteilung für Neurochirurgie, Wien, Österreich
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Alex Micko
- Medizinische Universität Wien, Abteilung für Neurochirurgie, Wien, Österreich
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Engelbert Knosp
- Medizinische Universität Wien, Abteilung für Neurochirurgie, Wien, Österreich
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Stereotactic interventions are amongst the most frequent procedures in cranial neurosurgery. To overcome the limitations of frame-based, frame-less arm-based, or free-hand techniques, robotic arms have been introduced with the goal to make these surgeries even more accurate and safe. We have developed a miniature robotic guidance system that could overcome these drawbacks. In our previous work we proved the device to be significantly more accurate for stereotactic biopsies and stereoencephalography (SEEG) procedures. The aim of this study is to evaluate the feasibility and accuracy of the robotic guidance device in stereotactic neurosurgical procedures and present our single center experience.
Methods: All patients underwent stereotactic neurosurgical procedures in the last 4 years. We conducted this approved study to assess the feasibility, setup and accuracy of the robotic guidance in 133 consecutive cases of tumor biopsy (n=100), intracranial catheter (n=10) and depth electrode placement (n=23 patients, n=138 electrodes).
Results: In this clinical trial, application of the robotic guidance system was feasible in all cases. A trajectory alignement error (TAE) of ≤0.1mm was calculated by the navigation system in all cases. For stereotactic biopsies, the median real target error (RTE) was 1.5 mm (range 0.2 – 5.1 mm) at entry points and 1.6 mm (range 0.0 – 3.9 mm) at target points. In SEEG procedures, a median real target error (RTE) of 1.1 mm (range 0.0 – 3.4 mm) at entry points and 1.5 mm (range 0.2 – 5.6 mm) at target points was revealed. In all cases of catheter placement, a satisfctory functional catheter position was achieved. No adverse effects related to the application of the robotic device were encountered.
Conclusion: Our single center results indicate that application of the miniature robotic guidance device in stereotactic neurosurgical procedures is feasible and provides high procedural accuracy without adding operating time. Due to its small form-factor, the robotic device was found to seamlessly integrate into the routine operating workflow.
