Skip to main content

Advertisement

SpringerLink
Log in

Stereotactic brain biopsy: evaluation of robot-assisted procedure in 60 patients

  • Original Article - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Frameless stereotactic biopsies, particularly robot-assisted procedures are increasing in neurosurgery centers. Results of these procedures should be at least equal to or greater than frame-based reference procedure. Evaluate robot-assisted technology is necessary in particular, when a team has chosen to switch from one to another method.

Objective

The objective of our prospective work was (i) to evaluate the success rate of contributive robotic-assisted biopsy in 60 patients, to report the morbidity and mortality associated with the procedure and (ii) to compare it with literature data.

Methods

We performed a prospective and descriptive study including 60 consecutive patients having had robotic-assisted stereotactic biopsy at the Rouen University Hospital, France. All patients had presurgical imaging before the procedure included Magnetic Resonance Imaging merged with Computed Tomography scan acquisition. Registration was mostly performed with a touch-free laser (57/60). A control Computed Tomography scan was always realized at day 0 or day 1 after surgery. Data collected were success rate, bleeding, clinical worsening, infection, and mortality.

Results

All the biopsies were considered as contributive and lead to the final diagnosis. In 41/60 patients (68%), the lesion was glial. Six in 60 patients (10%) had visible bleeding without clinical worsening related, 5/60 patients (8.5%) showed clinical impairment following surgery, which was permanent in 2 patients, and 1/60 patient presented generalized seizures. We did not report any infection and mortality.

Conclusion

Robot-assisted frameless surgery is efficient and provides a reasonable alternative to frame-based procedure. The operating time can be reduced, without increasing morbidity and mortality rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Abernathey CD, Camacho A, Kelly PJ (1989) Stereotaxic suboccipital transcerebellar biopsy of pontine mass lesions. J Neurosurg 70(2):195–200

    Article  CAS  PubMed  Google Scholar 

  2. Air EL, Leach JL, Warnick RE, McPherson CM (2009) Comparing the risks of frameless stereotactic biopsy in eloquent and noneloquent regions of the brain: a retrospective review of 284 cases. J Neurosurg 111:820–824

    Article  PubMed  Google Scholar 

  3. Balossier A, Blond S, Reyns N (2016) Endoscopic versus stereotactic procedure for pineal tumor biopsies: focus on overall efficacy rate. World Neurosurg 92:223–228

    Article  PubMed  Google Scholar 

  4. Barnett GH, Miller DW, Weisenberger J (1999) Frameless stereotaxy with scalp-applied fiducial markers for brain biopsy procedures: experience in 218 cases. J Neurosurg 91:569–576

    Article  CAS  PubMed  Google Scholar 

  5. Bekelis K, Radwan TA, Desai A, Roberts DW (2012) Frameless robotically targeted stereotactic brain biopsy: feasibility, diagnostic yield, and safety. J Neurosurg 116:1002–1006

    Article  PubMed  Google Scholar 

  6. Benabid AL, Cinquin P, Lavalle S, Le Bas JF, Demongeot J, De Rougemont J (1987) Computer-driven robot for stereotactic surgery connected to CT scan and magnetic resonance imaging: technological design and preliminary results. Appl Neurophysiol 50:153–154

    CAS  PubMed  Google Scholar 

  7. Benabid AL, Hoffmann D, Lavallee S, Cinquin P, Demongeot J, Le Bas JF (1991) Is there any future for robots in neurosurgery? Adv Tech Stand Neurosurg 18:3–45

    Article  CAS  PubMed  Google Scholar 

  8. Benabid AL, Lavallee S, Hoffmann D, Cinquin P, Demongeot J, Danel F (1992) Potential use of robots in endoscopic neurosurgery. Acta Neurochir Suppl (Wien) 54:93–97

    Article  CAS  Google Scholar 

  9. Bernays RL, Kollias SS, Khan N, Brandner S, Meier S, Yo-nekawa Y (2002) Histological yield, complications, and technological considerations in 114 consecutive frameless stereotactic biopsy procedures aided by open intraoperative magnetic resonance imaging. J Neurosurg 97:354–362

    Article  PubMed  Google Scholar 

  10. Bernstein M, Parrent AG (1994) Complications of CT-guided stereotactic biopsy of intra-axial brain lesions. J Neurosurg 81:165–168

    Article  CAS  PubMed  Google Scholar 

  11. Boviatsis EL, Kouyialis AT, Stranjalis G, Korfias S, Sakas DE (2003) CT-guided stereotactic biopsies of brain stem lesions: personal experience and literature review. Neurol Sci 24:97–107

    Article  CAS  PubMed  Google Scholar 

  12. Coca HA, Cebula H, Benmekhbi M, Chenard MP, Entz-Werle N, Proust F (2016) Diffuse intrinsic pontine gliomas in children: interest of robotic frameless assisted biopsy. A technical note. Neurochirurgie 62(6):327–331

    Article  CAS  PubMed  Google Scholar 

  13. Dammers R, Haitsma IK, Schouten JW, Kros JM, Avezaat CJJ, Vincent AJP (2008) Safety and efficacy of frameless and frame-based intracranial biopsy techniques. Acta Neurochir 150:23–29

    Article  CAS  PubMed  Google Scholar 

  14. De Benedictis A, Trezza A, Carai A, Genovese E, Procaccini E, Messina R (2017) Robot-assisted procedures in pediatric neurosurgery. Neurosurg Focus E7:10.3171

    Google Scholar 

  15. Dellaretti M, Reyns N, Touzet G, Dubois F, Gusmão S, Pereira JLB (2012) Stereotactic biopsy for brainstem tumors: comparison of transcerebellar with transfrontal approach. Stereotact Funct Neurosurg 90:79–83

    Article  PubMed  Google Scholar 

  16. Dorward NL, Alberti O, Palmer JD, Kitchen ND, Thomas DG (1999) Accuracy of true frameless stereotaxy: in vivo measurement and laboratory phantom studies. Technical note. J Neurosurg 90:160–168

    Article  CAS  PubMed  Google Scholar 

  17. Dorward NL, Paleologos TS, Alberti O, Thomas DG (2002) The advantages of frameless stereotactic biopsy over frame-based biopsy. Br J Neurosurg 16:110–118

    Article  CAS  PubMed  Google Scholar 

  18. Drake JM, Joy M, Goldenberg A, Kreindler D (1991) Computer and robot-assisted resection of thalamic astrocytomas in children. Neurosurgery 29:27–33

    Article  CAS  PubMed  Google Scholar 

  19. Eljamel M (2008) Robotic applications in neurosurgery. Med Robots 1:1–24

    Google Scholar 

  20. Faria C, Erlhagen W, Rito M, De Momi E, Ferrigno G, Bicho E (2015) Review of robotic technology for stereotactic neurosurgery. IEEE Rev Biomed Eng 8:125–137

    Article  PubMed  Google Scholar 

  21. Field M, Witham TF, Flickinger JC, Kondziolka D, Lunsford LD (2004) Comprehensive assessment of haemorrhage risks and outcomes after stereotactic brain biopsy. J Neurosurg 94:545–551

    Article  Google Scholar 

  22. Frank F, Fabrizi AP, Frank-Ricci R, Gaist G, Sedan R, Peragut GC (1988) Stereotactic biopsy and treatment of brain stem lesions: combined study of 33 cases (Bologna-Marseille). Acta Neurochir 42:177–181

    CAS  Google Scholar 

  23. Frank F, Fabrizi AP, Frank-Ricci R, Gaist G, Sédan R, Peragut JC (1988) Stereotactic biopsy and treatment of brainstem lesions: combined study of 33 cases (Bologna-Marseille). Acta Neurochir Suppl (Wien) 42:177–181

    CAS  Google Scholar 

  24. Frazier JL, Lee J, Thomale UW, Noggle JC, Cohen KJ, Jallo G (2009) Treatment of diffuse intrinsic brainstem gliomas: failed approaches and futures strategies. J Neurosurg Pediatr 3:259–269

    Article  Google Scholar 

  25. Giese H, Hoffmann KT, Winkelmann A, Stockhammer F, Jallo GI, Thomale UW (2010) Precision of navigated stereotactic probe implantation into the brainstem. J Neurosurg Pediatr 5(4):350–359

    Article  PubMed  Google Scholar 

  26. Golfinos JG, Fitzpatrick BC, Smith LR, Spetzler RF (1995) Clinical use of a frameless stereotactic arm: results of 325 cases. J Neurosurg 1983:197–205

    Article  Google Scholar 

  27. Gralla J, Nimsky C, Buchfelder M, Fahlbusch R, Ganslandt O (2003) Frameless stereotactic brain biopsy procedures using the Stealth Station: indications, accuracy and results. Zentralbl Neurochir 64:166–170

    Article  CAS  PubMed  Google Scholar 

  28. Grimm F, Naros G, Gutenberg A, Keric N, Giese A, Gharabaghi A (2015) Blurring the boundaries between frame-based and frameless stereotaxy: feasibility study for brain biopsies performed with the use of a head-mounted robot. J Neurosurg 123:737–742

    Article  PubMed  Google Scholar 

  29. Grossman R, Sadetzki S, Spiegelmann R, Ram Z (2005) Haemorrhagic complications and the incidence of asymptomatic bleeding associated with stereotactic brain biopsies. Acta Neurochir 147:627–631

    Article  CAS  PubMed  Google Scholar 

  30. Guthrie BL, Steinberg GK, Adler JR (1989) Posterior fossa stereotaxic biopsy using the Brown-Roberts-Wells stereotaxic system. Neurosurgery 70:649–652

    Article  CAS  Google Scholar 

  31. Guy G, Jan M, Guégan Y, Aubin ML, Fischer C, Ben-Hassel M (1989) Surgical lesions of the brain stem. Neurochirurgie 1(35):1–133

    Google Scholar 

  32. Haegelen C, Touzet G, Reyns N, Maurage CA, Ayachi M, Blond S (2010) Stereotactic robot-guided biopsies of brain stem lesions: experience with 15 cases. Neurochirurgie 56:363–367

    Article  CAS  PubMed  Google Scholar 

  33. Hood TW, Gebarski SS, McKeever PE, Venes JL (1986) Stereotaxic biopsy of intrinsic lesions of the brain stem. J Neurosurg 65:172–176

    Article  CAS  PubMed  Google Scholar 

  34. Lefranc M, Touzet G, Caron S, Maurage CA, Assaker R, Blond S (2011) Are stereotactic sample biopsies still of value in the modern management of pineal region tumours? Lessons from a single-department, retrospective series. Acta Neurochir 153:1111–1122

    Article  PubMed  Google Scholar 

  35. Lefranc M, Capel C, Pruvot AS, Fichten A, Desenclos C, Toussaint P (2014) The impact of the reference imaging modality, registration method and intraoperative flat-panel computed tomography on the accuracy of the ROSA® stereotactic robot. Stereotact Funct Neurosurg 92:242–250

    Article  PubMed  Google Scholar 

  36. Lefranc M, Capel C, Pruvot-Occean AS, Fichten A, Desenclos C, Toussaint P (2015) Frameless robotic stereotactic biopsies: a consecutive series of 100 cases. J Neurosurg 122(2):342–352

    Article  PubMed  Google Scholar 

  37. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (2016) World Health Organization histological classification of tumours of the central nervous system 2016. International Agency for Research on Cancer, France

    Google Scholar 

  38. Nathoo N, Cavuşoğlu MC, Vogelbaum MA, Barnett GH (2005) In touch with robotics: neurosurgery for the future. Neurosurgery 56:421–433

    Article  PubMed  Google Scholar 

  39. Rachinger W, Grau S, Holtmannspötter M (2009) Serial stereotactic biopsy of brainstem lesions in adults improves diagnostic accuracy compared with MRI only. J Neurol Neurosurg Psychiatry 80:1134–1139

    Article  CAS  Google Scholar 

  40. Rajshekhar V, Chandy MJ (1995) Computerized tomography-guided stereotactic surgery for brain stem masses: a risk-benefit analysis of 71 patients. J Neurosurg 8:976–981

    Article  Google Scholar 

  41. Regis J, Bouillot P, Rouby-Volot F, Figarella-Branger D, Dufour H, Peragut J (1996) Pineal region tumours and the role of stereotactic biopsy: review of the mortality, morbidity, and diagnostic rates in 370 cases. Neurosurgery 39(5):907–914

    CAS  PubMed  Google Scholar 

  42. Roessler K, Ungersboeck K, Aichholzer M, Dietrich W, Goerzer H, Matula C (1998) Frameless stereotactic lesion contour-guided surgery using a computer-navigated microscope. Surg Neurol 49:282–289

    Article  CAS  PubMed  Google Scholar 

  43. Roujeau T, Machado G, Garnett MR, Miquel C, Puget S (2007) Stereotactic biopsy of diffuse pontine lesions in children. J Neurosurg 107(1):1–4

    Article  Google Scholar 

  44. Samadani U, Stein S, Moonis G, Sonnad SS, Bonura P, Judy K (2006) Stereotactic biopsy of brain stem masses: decision analysis and literature review. Surg Neurol 66:484–491

    Article  PubMed  Google Scholar 

  45. Smith JS, Quiñones-Hinojosa A, Barbaro NM, McDermott MW (2005) Frame-based stereotactic biopsy remains an important diagnostic tool with distinct advantages over frameless stereotactic biopsy. J Neuro-Oncol 73:173–179

    Article  Google Scholar 

  46. St George EJ, Walsh AR, Sgouros S (2004) Stereotactic biopsy of brain tumours in the paediatric population. Childs Nerv Syst 20:163–167

    Article  CAS  PubMed  Google Scholar 

  47. Sutherland GR, Lama S, Gan LS, Wolfsberger S, Zereinia K (2013) Merging machines with microsurgery: clinical experience with neuroArm. J Neurosurg 118:521–529

    Article  PubMed  Google Scholar 

  48. Ulm AJ, Bova FJ, Friedman WA (2001) Stereotactic biopsy aided by a computer graphics workstation: experience with 200 consecutive cases. Surg Neurol 56:366–372

    Article  CAS  PubMed  Google Scholar 

  49. Woodworth GF, McGirt MJ, Samdani A, Garonzik I, Olivi A, Weingart JD (2006) Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique. J Neurosurg 104:233–237

    Article  PubMed  Google Scholar 

  50. Zamorano L, Li Q, Jain S, Kaur G (2004) Robotics in neurosurgery: state of the art and future technological challenges. Int J Med Robot Comput Assist Surg 1(1):7–22

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Nikki Sabourin-Gibbs, Rouen University Hospital, for her help in editing the manuscript.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France

    Laura Terrier, Vianney Gilard & Stéphane Derrey

  2. Department of Pathology, Rouen University Hospital, 76000, Rouen, France

    Florent Marguet

  3. Department of Oncology, Rouen University Hospital, 76000, Rouen, France

    Maxime Fontanilles

  4. Department of Neurosurgery, Rouen University Hospital, Normandie University, UNIROUEN, INSERM UMR, 1073, F 76000, Rouen, France

    Stéphane Derrey

Authors
  1. Laura Terrier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vianney Gilard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Florent Marguet
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maxime Fontanilles
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stéphane Derrey
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LT wrote the manuscript. VG was a major contributor in writing the manuscript. SD performed the surgeries and described and revised the manuscript. FM and MF supervised and revised the manuscript. All authors have read and approved the submitted manuscript.

Corresponding author

Correspondence to Laura Terrier.

Ethics declarations

Conflict of interest

Authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement of informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Brain Tumors

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Terrier, L., Gilard, V., Marguet, F. et al. Stereotactic brain biopsy: evaluation of robot-assisted procedure in 60 patients. Acta Neurochir 161, 545–552 (2019). https://doi.org/10.1007/s00701-019-03808-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-019-03808-5

Keywords

Search

Navigation