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Robot-assisted stereotactic brainstem biopsy in children: prospective cohort study
William Dawes1, Hani J Marcus2,3, Martin Tisdall1
1Department of Neurosurgery, Great Ormond Street Hospital, London, UK.
Journal of Robotic Surgery
|December 8, 2018
Summary
Robot-assisted surgery for pediatric brainstem tumors is feasible and safe. This technique allows for precise biopsies, yielding diagnostic specimens in most cases with no reported complications.
Area of Science:
- Neurosurgery
- Pediatric Oncology
- Robotic Surgery
Background:
- Brainstem tumors represent about 10% of pediatric brain tumors.
- Surgical biopsy of brainstem tumors is complex and carries significant risks.
- Robot-assisted surgery offers potential for enhanced accuracy and precision in neurosurgical procedures.
Purpose of the Study:
- To evaluate the feasibility and safety of robot-assisted stereotactic biopsy using the Neuromate robot in children with brainstem tumors.
- To assess the accuracy of the robot-assisted technique by measuring target point localization error (TPLE).
Main Methods:
- An uncontrolled prospective cohort study (Phase II) was conducted.
- Eleven children with brainstem tumors underwent robot-assisted stereotactic biopsy between December 2015 and November 2017.
- Post-operative MRI scans were compared with pre-operative plans to determine TPLE; adverse events were prospectively recorded.
Main Results:
- Diagnostic specimens were obtained in 10 out of 11 cases; the remaining case required a second biopsy.
- Diffuse Intrinsic Pontine Glioma (DIPG) was the most common pathology (7/15 cases).
- The median TPLE was 2.7 mm (range 0.5-4.2 mm) based on early post-operative volumetric MRI in 7 patients. No surgical complications were reported.
Conclusions:
- Robot-assisted stereotactic biopsy is a feasible and safe approach for pediatric brainstem tumors.
- The technique demonstrates promising accuracy in target localization.
- Further research, including comparative studies, is recommended to validate these findings.
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