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Image-guided biopsy of intracranial lesions in children, with a small robotic device: a case series

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Abstract

Background and objectives

Robot-assisted biopsies have gained popularity in the last years. Most robotic procedures are performed with a floor-based robotic arm. Recently, Medtronic Stealth Autoguide, a miniaturized robotic arm that work together with an optical neuronavigation system, was launched. Its application in pediatric cases is relatively unexplored. In this study, we retrospectively report our experience using the Stealth Autoguide, for frameless stereotactic biopsies in pediatric patients.

Methods

Pediatric patients who underwent stereotactic biopsy using the Stealth Autoguide cranial robotic platform from July 2020 to May 2023 were included in this study. Clinical, neuroradiological, surgical, and histological data were collected and analyzed.

Results

Nineteen patients underwent 20 procedures (mean age was 9-year-old, range 1–17). In four patients, biopsy was part of a more complex surgical procedure (laser interstitial thermal therapy — LITT). The most common indication was diffuse intrinsic brain stem tumor, followed by diffuse supratentorial tumor. Nine procedures were performed in prone position, eight in supine position, and three in lateral position. Facial surface registration was adopted in six procedures, skull-fixed fiducials in 14. The biopsy diagnostic tissue acquisition rate was 100% in the patients who underwent only biopsy, while in the biopsy/LITT group, one case was not diagnostic. No patients developed clinically relevant postoperative complications.

Conclusion

The Stealth Autoguide system has proven to be safe, diagnostic, and highly accurate in performing stereotactic biopsies for both supratentorial and infratentorial lesions in the pediatric population.

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Availability of data and material

No datasets were generated or analysed during the current study.

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Neurosciences, Division of Neurosurgery, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore 6, 80121, Naples, Italy

    Pietro Spennato, Marianna Di Costanzo, Giuseppe Mirone, Nicola Onorini, Claudio Ruggiero & Giuseppe Cinalli

  2. Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy

    Marianna Di Costanzo

  3. Department of Neurosciences, Division of Neuroradiology, Santobono-Pausilipon Children’s Hospital, Naples, Italy

    Domenico Cicala

  4. Department of Onco-Hematology, Unit of Neuro-oncology, Santobono-Pausilipon Children’s Hospital, Naples, Italy

    Lucia De Martino

Authors
  1. Pietro Spennato
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  2. Marianna Di Costanzo
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  3. Giuseppe Mirone
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  4. Domenico Cicala
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  5. Lucia De Martino
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  6. Nicola Onorini
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  7. Claudio Ruggiero
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  8. Giuseppe Cinalli
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Contributions

Editing and drafting manuscript: MDC, PS, CR. Reviewing pre-operative and post-operative images: DC, GM. Reviewing images on neuronavigation work-station: GM. Reviewing the literature: MDC, PS, LDM; Reviewing patients charts and history: MDC, LDM. Critically revising the work: GC, PS. Approved the final version of the work on behalf of all authors: PS. Supervision: GC. All authors reviewed the manuscript.

Corresponding author

Correspondence to Pietro Spennato.

Ethics declarations

Ethics approval and consent to participate

All procedures performed in the studies involving human participants conformed to the ethical standards of the institutional and/or national research committee and the 1964 Declaration of Helsinki and its subsequent amendments or comparable ethical standards. Written informed consent was obtained from the parents for publication of the details of the medical case and associated images. Because this was a retrospective case report and all procedures performed were part of routine care, the study was exempt from ethical approval by the institutional review board.

Conflict of interest

The authors declare no competing interests.

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Spennato, P., Di Costanzo, M., Mirone, G. et al. Image-guided biopsy of intracranial lesions in children, with a small robotic device: a case series. Childs Nerv Syst (2024). https://doi.org/10.1007/s00381-024-06349-0

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