Robot-guided Stereotactic Biopsy for Intracranial Tumors - A Feasibility Study

Introduction: Robot assisted surgery is progressively being applied in clinical routine. Technical advances offer increased opportunities in cranial as well as spinal neurosurgery. This study analyzed the impact and potential benefits of the intraoperative use of a robotic arm for cranial biopsy.

Methods: Patients were prospectively enrolled. Cranial biopsy was performed using a robotic arm for the automatic alignment of the preoperatively planned trajectory. Surgeons perspective, histopathological findings and clinical data were acquired.

Results: Overall, 11 patients were included with a volume of the lesion of 25.3 +/- 24.6 (range 1.0 – 66.9) cm3. Robot assisted biopsy was successfully performed in all cases, taking biopsies at the planned sites. No complications occurred intraoperatively. The duration of surgery was 21 +/- 10 (7-38) min. Histopathological samples could be obtained in all cases (4 primary brain tumors, 4 intracranial infections, 2 lymphoma, 1 vasculitis). Postoperatively, one patient showed neurological deterioration. The system was rated on a numeric rating scale (1-10) by the operating surgeons, showing high satisfaction regarding handling of software (median 10 (8-10)), hardware (median 9 (8-10)), duration of the alignment for biopsy (median 10 (5-10)) and patient safety (median 10 (8-10)). Mental load was being rated on a scale ranging from 0 (no effort at all) to 150 (unsolvable exceptional effort). The alignment of the robotic arm was rated with a median mental load of 20 (10-120), while placing the bone anchor and drill guide was rated with a median of 20 (10-30) and trephination was rated with a median of 10 (0-30).

Conclusion : Robot assisted surgery appears safe and feasible in cranial surgery, offering new potentials. However, further data is needed to evaluate and specify benefits in clinical routine.