Robotic arm vs. stereotactic frame in deep brain stimulation surgery for movement disorders: a retrospective cohort study

Abstract

BACKGROUND: Recently, robotic arms have been incorporated into the implantation of electrodes for deep brain stimulation (DBS).This study aimed to determine the accuracy of brain electrode placement, initial clinical efficacy, and safety profile of the robotic arm Neuromate (Renishaw) compared to a stereotactic frame in movement disorders. METHODS: This study involved two retrospective cohorts: one cohort was operated on using a stereotactic frame and the other with a robotic arm. This study was conducted at Barcelona Hospital Clinic. RESULTS: Seventy-seven patients were included, of whom 30 underwent surgery using the robot and 47 using a stereotactic frame. The postoperative improvement percentage of the Unified Parkinson's Disease Rating Scale at 3 months was similar in both groups (robot: 71.4 ± 18 vs. frame: 72.6% ± 17, P = 0.82). There were no significant differences in the perioperative complications (robot: 4% vs. frame: 4.3%, P = 0.93) or in the adverse reactions related to brain stimulation and medical treatment (robot: 18% vs. frame: 25%, P = 0.53). There was a slight improvement in the anatomical-radiological accuracy of brain electrode implantation assisted by the robotic arm, measured using radial error (robot: 1.01 ± 0.5 mm vs. frame: 1.32 ± 0.6 mm, P = 0.03). CONCLUSIONS: Both systems (robotic and stereotactic frame) exhibited similar initial clinical efficacies and safety profiles. The use of the robotic arm Neuromate slightly improved the anatomical-radiological accuracy in the placement of DBS electrodes for movement disorders compared with the stereotactic frame.