Experience with 102 frameless stereotactic biopsies using the neuromate® robotic device.

OBJECTIVE: Stereotactic biopsy is a standard procedure in neurosurgery. In addition to or even replacing frame-based stereotaxy some centers also utilize frameless imaging-based techniques and more recently robotic systems. Here we report a retrospective analysis of our experience with 102 consecutive biopsies performed in our institution using the neuromate® robotic device.

METHODS: Between March 2013 and April 2018, 102 robot-assisted frameless biopsies were performed in 100 consecutive patients (median age/ range: 66/ 7-86 yrs., male: 64). Target lesions were deep-seated (insula, basal ganglia, thalamus, midbrain, cerebellar peduncle) in 29 (28.4%) and/or small (< 15 mm) in 24 (23.5%) cases. We retrospectively analyzed the histopathological results as well as complications and the duration of the procedures.

RESULTS: A definite histological diagnosis could be established in 94/102 procedures (92.2%; 94/100 patients = 94.0%) including 67 glial and glioneuronal tumors, 16 CNS lymphomas, 7 metastases, 1 PNET and 5 cases with inflammatory or infectious disorders. There were no infectious complications. 13 cases (12.7%) suffered from biopsy-related hemorrhages > 10 mm, however persistent surgery-related neurological worsening was seen in only 3 (2.9%). The average operating time was 10 min for placement of the localizing device under local anesthesia and 30 min for the actual biopsy procedure.

CONCLUSIONS: Robot-assisted fameless stereotactic biopsies using the neuromate® robot are an alternative to frame-based stereotaxy with a similar diagnostic yield and comparable complication rates.