Robot-assisted vs. Conventional Frame-based Stereotactic Approaches for Deep Brain Stimulation Electrode Placement: Perioperative Outcomes

Introduction: Several surgical approaches currently exist for placement of deep brain stimulation (DBS) electrodes in Parkinson’s disease (PD) and essential tremor (ET). We aimed to compare perioperative clinical outcomes after robotic-lead implantation versus a frame-based approach.

Methods: We retrospectively collected electronic medical data from 73 patients who had successful DBS electrode implantation for PD or ET (2016 – 2022). Data included clinical diagnosis, stereotactic approach and target selection, demographics, surgery length, intraoperative and postoperative complications, length of stay, and readmission rates. We compared the effect of robotic vs. frame-based approaches on outcomes.

Results: Thirty-four patients received the frame-based approach vs. 39 with robotic placement. Mean age was 69 years and 73% (n: 52) men. Sixty patients (82%) were diagnosed with Parkinson’s disease and 13 (18%) with essential tremor. PD was more common in robotic patients (92% vs. 71%, p=0.016). Operative time (184 vs. 180 minutes, p=0.371), estimated blood loss (20 vs. 25ml, p=0.45), and hospital length of stay (2.15 vs. 1.7 days, p=0.452) were comparable between groups. There were no intraoperative complications reported in either surgical group. No electrode revisions (0%) were required in either group. The rates of medical (5.1% vs. 0%, p=0.495) and surgical (5.1% vs. 0%, p=0.495) complications were higher in the robotic group but was not statistically significant. The rates of readmissions between groups were comparable (7.6% vs. 2.9%, p=0.374).

Conclusion : Our institutional experience between robotic and frame-based DBS suggests that both methods are equally safe and efficacious in addressing PD or ET without significant benefit in operative time or complication rates. Surgeons should use the method with which they have the most comfort and experience.