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. 2020 Sep 15;19(4):444-452.
doi: 10.1093/ons/opaa029.

Robotic-Assisted Stereotaxy for Deep Brain Stimulation Lead Implantation in Awake Patients

Amir H Faraji  1 , Vasileios Kokkinos  2 , James C Sweat  1 , Donald J Crammond  1 , R Mark Richardson  2
Affiliations

Robotic-Assisted Stereotaxy for Deep Brain Stimulation Lead Implantation in Awake Patients

Amir H Faraji et al. Oper Neurosurg. .

Abstract

Background: Robotic-assisted stereotaxy has been increasingly adopted for lead implantation in stereoelectroencephalography based on its efficiency, accuracy, and precision. Despite initially being developed for use in deep brain stimulation (DBS) surgery, adoption for this indication has not been widespread.

Objective: To describe a recent robotic-assisted stereotaxy experience and workflow for DBS lead implantation in awake patients with and without microelectrode recording (MER), including considerations for intraoperative research using electrocorticography (ECoG).

Methods: A retrospective review of 20 consecutive patients who underwent simultaneous bilateral DBS lead implantation using robotic-assisted stereotaxy was performed. Radial error was determined by comparing the preoperative target with the DBS lead position in the targeting plane on postoperative computed tomography. Information regarding any postoperative complications was obtained by chart review.

Results: A novel method for robot coregistration was developed. We describe a standard workflow that allows for MER and/or ECoG research, and a streamlined workflow for cases in which MER is not required. 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 with the second 10 patients (0.86 ± 0.09 mm). No complications were encountered.

Conclusion: Robotic-assisted stereotaxy has the potential to increase precision and reduce human error, compared to traditional frame-based DBS surgery, without negatively impacting patient safety or the ability to perform awake neurophysiology research.

Keywords: Deep brain stimulation; Robotic-assisted stereotaxy.

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Figures

FIGURE 1.
FIGURE 1.
Microdrive setup and ROSA measurements. The ROSA is positioned at a distance from target based upon measurements of the ROSA adapter, Neuro Omega microdrive, and guide tube length.
FIGURE 2.
FIGURE 2.
Typical operating setup. The ROSA is positioned in line with the patient, whose head is elevated to the maximum height possible for attachment of the Leksell frame to the ROSA. A clear operative drape is used to facilitate monitoring of the patient during the “awake” portions of the case.
FIGURE 3.
FIGURE 3.
Setting fiducial points on the frame CT. For each of 4 registration points, the center of the titanium pin head is identified on the CT scan and these locations are set as “marker” reference points (green circles) in the ROSA software.
FIGURE 4.
FIGURE 4.
Registration of a frame pin. The ROSA registration tool is shown positioned in the center of the titanium pin opening at the site of the registration marker. The circle corresponding to the registration marker tool has been enhanced in this figure for readability.
FIGURE 5.
FIGURE 5.
Patient positioning for MER and ECoG. A, ROSA arm in target position, supporting the microdrive and 3 microelectrodes, with the implantation of 2 strip electrodes evidenced by their wires protruding from the burr hole (red arrowhead) seen below the ROSA arm. B, Attachment to the ROSA does not preclude the patient from participating comfortably in behavioral research tasks during intracranial recording.
See this image and copyright information in PMC

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