Techniques of Frameless Robot-Assisted Deep Brain Stimulation and Accuracy Compared with the Frame-Based Technique.

BACKGROUND: Frameless robot-assisted deep brain stimulation (DBS) is an innovative technique for leads implantation. This study aimed to evaluate the accuracy and precision of this technique using the Sinovation SR1 robot.

METHODS: 35 patients with Parkinson's disease who accepted conventional frame-based DBS surgery ( n = 18) and frameless robot-assisted DBS surgery ( n = 17) by the same group of neurosurgeons were analyzed. The coordinate of the tip of the intended trajectory was recorded as xi , yi , and zi . The actual position of lead implantation was recorded as xa, ya, and za. The vector error was calculated by the formula of √(xi - xa )2 + (yi - ya )2 + (zi - za )2 to evaluate the accuracy.

RESULTS: The vector error was 1.52 ± 0.53 mm (range: 0.20-2.39 mm) in the robot-assisted group and was 1.77 ± 0.67 mm (0.59-2.98 mm) in the frame-based group with no significant difference between two groups ( p = 0.1301). In 10.7% ( n = 3) frameless robot-assisted implanted leads, the vector error was greater than 2.00 mm with a maximum offset of 2.39 mm, and in 35.5% ( n = 11) frame-based implanted leads, the vector error was larger than 2.00 mm with a maximum offset of 2.98 mm. Leads were more posterior than planned trajectories in the robot-assisted group and more medial and posterior in the conventional frame-based group.

CONCLUSIONS: Awake frameless robot-assisted DBS surgery was comparable to the conventional frame-based technique in the accuracy and precision for leads implantation.