Stereotactic robotic transcerebellar-transpeduncular pontomedullary biopsy: illustrative case

Brainstem biopsy using several robot-assisted platforms is well described in the literature. It has been endorsed as a feasible, safe, and highly accurate minimally invasive method of obtaining a histological diagnosis that can guide treatment. This paper is the first to report the use of the Medtronic Stealth Autoguide for a pontomedullary biopsy in an adult patient.

A transcerebellar-transpeduncular stereotactic biopsy using the Medtronic Stealth Autoguiderobotic guidance system is described, including surgical steps and registration technique. Workflow, trajectory, diagnostic accuracy, and complications are reported. The total operative time was 56 minutes. The intended target was reached, and diagnostic tissue was obtained with the described biopsy technique. Postoperative imaging demonstrated a small hemorrhage at the biopsy site, and the patient experienced a transient worsening of dysphagia. Final pathological analysis confirmed glioblastoma, WHO grade 4, and immunohistochemistical analysis confirmed a deficiency in DNA mismatch repair protein.

This illustrative case represents the first documented application of the Medtronic Stealth Autoguide robotic platform to complete a transcerebellar-transpeduncular biopsy of a pontomedullary lesion in an adult and adds to the existing literature regarding the high rates of efficacy, safety, and diagnostic success of this robot-assisted platform. https://thejns.org/doi/10.3171/CASE26111.