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Robotic alignment system Cirq (Brainlab) for navigated brain tumor biopsies in children

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Abstract

Introduction

The Cirq robotic alignment system (Brainlab, Munich, Germany) is a manually adjustable electronic arm with a robotic alignment module on its distal end, enabling the neurosurgeon to automatically and accurately align surgical instruments to a preoperatively planned trajectory. In this study, we share our first experiences and results using Cirq for intracranial tumor biopsy in children.

Methods

From May 2021 until October 2022, all consecutive patients that underwent a brain tumor biopsy using Cirq were included and compared to a historical cohort of patients biopsied with the non-robotic system Varioguide (Brainlab, Munich, Germany). Patient-related data, tumor-related data, and surgery-related data were collected. Registration accuracy was calculated for different patient-to-image registration methods. Pre- and postoperative images were fused, and entry error, target error, and angulation error were calculated.

Results

Thirty-seven patients, aged 1–19 years, were included (14 with Cirq and 23 with Varioguide). An integrated histopathological and molecular diagnosis was acquired in all cases. Patient-to-image registration was significantly more accurate when based on bone screw fiducials combined with intraoperative CT, as compared to surface matching or skin fiducials. The target error (Euclidian distance) was 5.3 mm for Cirq as compared to 8.3 mm for Varioguide, but this was not statistically significant. Entry error and angulation error were also not significantly different between both groups.

Conclusion

Intracranial biopsy with the Cirq robotic system is feasible and safe, and its accuracy does not differ from the Varioguide system.

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Authors and Affiliations

  1. Department of Neuro-Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands

    Kirsten M. van Baarsen, Darwin E. A. Woodley, Peter A. Woerdeman, Kuo S. Han & Eelco W. Hoving

  2. Department of Pediatric Neurosurgery, Utrecht University Medical Center/Wilhelmina Children’s Hospital, Utrecht, The Netherlands

    Kirsten M. van Baarsen, Darwin E. A. Woodley, Peter A. Woerdeman, Kuo S. Han & Eelco W. Hoving

  3. Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands

    K. Mariam Slot

Authors
  1. Kirsten M. van Baarsen
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  2. Darwin E. A. Woodley
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  3. K. Mariam Slot
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  4. Peter A. Woerdeman
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  5. Kuo S. Han
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  6. Eelco W. Hoving
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Contributions

KvB and DW wrote the main manuscript text and made all figures. All authors critically reviewed the manuscript and contributed in data collection.

Corresponding author

Correspondence to Kirsten M. van Baarsen.

Ethics declarations

Ethics approval

The research was approved by our Biobank and Data Access Committee under number PMCLAB2022.302.

Conflict of interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The Cirq robotic arm was generously donated by the Semmy Foundation (Stichting Semmy) for children with brainstem tumors. Brainlab was not involved in preparation of this manuscript.

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Publisher's Note

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Part of this work has been presented as a poster presentation on Society of Neuro Oncology, virtual conference on Intraoperative Visualization and the Connectome, 6–7 December 2021. 

Part of this work has been presented as a poster presentation on the International Society for Pediatric Neuro-Oncology (ISPNO) conference, Hamburg, 12–15 June 2022. 

Part of this work has been presented as an oral presentation on the European Association of Neurosurgical Societies (EANS) pre-congress for students, Belgrade, 15 October 2022.  

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van Baarsen, K.M., Woodley, D.E.A., Slot, K. et al. Robotic alignment system Cirq (Brainlab) for navigated brain tumor biopsies in children. Childs Nerv Syst 40, 99–108 (2024). https://doi.org/10.1007/s00381-023-06060-6

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  • DOI: https://doi.org/10.1007/s00381-023-06060-6

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