Stereotactic ROBOT-Assisted Deep Brain Stimulation Workflow: Incorporating the ROSA-Brain System Into the Functional Neurosurgical Practice

Abstract

INTRODUCTION: Modern robotic-assisted stereotaxy has been increasingly adopted for neurosurgical procedures. Accuracy and precision are paramount in deep brain stimulation (DBS) surgery, and robotic control may improve surgical outcomes and precision. We developed 2 frame-based workflows for DBS: (1) without microelectrode recordings and (2) with microelectrode recordings and the possibility for intraoperative electrocorticography, and reported on lead placement accuracy and complications. METHODS: A consecutive single-surgeon cohort of 20 patients underwent stage 1 DBS (targets included VIM, STN, GPi) with frame-based ROSA-Brain robotic assistance. Radial error accuracy was retrospectively established with two blinded raters comparing pre- and postoperative DBS lead trajectories. Total operative case time was obtained from nursing documentation and postoperative complications were documented. RESULTS: A systematic method for ROSA-Brain co-registration was developed to allow for DBS: (1) without microelectrode recordings and (2) with microelectrode recordings and the possibility for intraoperative electrocorticography. The overall radial error for lead placement across all 20 patients was 1.14+/−0.11 mm. A significant difference (P = .006) existed between the radial error of the first 10 patients (1.46+/−0.19 mm) as compared to the second 10 patients (0.86+/−0.09 mm). Overall, the total OR case time is at par with previously reported robotic-assisted DBS cases. CONCLUSION: Robotic-assisted DBS surgery, such as with the ROSA-Brain platform, has the potential to increase precision and reduce the human error associated with multiple measurements using traditional frame-based surgery without significantly impacting operating room workflow.