Abstract：
OBJECTIVE: Stereotactic techniques play an important role in neurosurgery. The development of a miniaturized cranial robot with an efficient workflow and accurate surgical execution is an important step in a broader application of these techniques. Herein, the authors describe their experience with the Medtronic Stealth Autoguide miniaturized cranial robot.
METHODS: A retrospective review of 75 cases from 2020 to 2022 was performed. The patients who had undergone surgery utilizing the Stealth Autoguide robot were analyzed for surgical indication and accuracy, operative time, and clinical outcome. The outcomes were defined as follows: for stereoelectroencephalography (SEEG), the electrode placement pattern that identified the seizure focus and did not require any revision or additional leads; for biopsy, the percentage of cases in which diagnostic tissue was obtained; and for laser interstitial thermal therapy (LITT), the percentage of cases in which laser fiber placement was adequate for ablation. Surgical complications were defined as any asymptomatic or symptomatic intracerebral hemorrhage, new neurological deficit, or need for electrode, laser fiber, or biopsy needle repositioning or revision.
RESULTS: The Stealth Autoguide robot was utilized in 75 on-label cases, including 40 SEEG cases for seizure focus localization, 19 LITT cases, and 16 stereotactic biopsy cases. The mean real target error (RTE) at the entry was 1.48 ± 0.84 mm for biopsy, 1.36 ± 0.89 mm for Visualase laser fiber placement, and 1.24 ± 0.72 mm for SEEG. The mean RTE at the target was 1.56 ± 0.95 mm for biopsy needle placement, 1.42 ± 0.93 mm for Visualase laser fiber placement, and 1.31 ± 0.87 mm for SEEG electrode placement. The surgical time for unilateral SEEG cases took an average 52 minutes (average 6.5 mins/lead, average 8 electrodes). Bilateral SEEG cases took an average 105 minutes (average 7.5 mins/lead, average 14 electrodes). In the SEEG population, there were no revised or unsuccessful seizure localizations. For biopsy, diagnostic tissue was obtained in 100% of cases. For LITT, fiber placement was adequate for ablation in 100% of cases. There were no cases of symptomatic or asymptomatic intracerebral hemorrhage, and no cases required repositioning or replacement of the laser fiber, electrode, or biopsy needle. One patient experienced transient cranial nerve III palsy following laser ablation that resolved in 10 weeks. A failure of communication between the robotic platform and the Stealth Autoguide as a station required the cancellation of 1 procedure.
CONCLUSIONS: The Medtronic Stealth Autoguide robot system is versatile across biopsy, SEEG, and laser ablation indications. Setup and surgical execution are efficient with a high degree of accuracy and consistency.
METHODS: A retrospective review of 75 cases from 2020 to 2022 was performed. The patients who had undergone surgery utilizing the Stealth Autoguide robot were analyzed for surgical indication and accuracy, operative time, and clinical outcome. The outcomes were defined as follows: for stereoelectroencephalography (SEEG), the electrode placement pattern that identified the seizure focus and did not require any revision or additional leads; for biopsy, the percentage of cases in which diagnostic tissue was obtained; and for laser interstitial thermal therapy (LITT), the percentage of cases in which laser fiber placement was adequate for ablation. Surgical complications were defined as any asymptomatic or symptomatic intracerebral hemorrhage, new neurological deficit, or need for electrode, laser fiber, or biopsy needle repositioning or revision.
RESULTS: The Stealth Autoguide robot was utilized in 75 on-label cases, including 40 SEEG cases for seizure focus localization, 19 LITT cases, and 16 stereotactic biopsy cases. The mean real target error (RTE) at the entry was 1.48 ± 0.84 mm for biopsy, 1.36 ± 0.89 mm for Visualase laser fiber placement, and 1.24 ± 0.72 mm for SEEG. The mean RTE at the target was 1.56 ± 0.95 mm for biopsy needle placement, 1.42 ± 0.93 mm for Visualase laser fiber placement, and 1.31 ± 0.87 mm for SEEG electrode placement. The surgical time for unilateral SEEG cases took an average 52 minutes (average 6.5 mins/lead, average 8 electrodes). Bilateral SEEG cases took an average 105 minutes (average 7.5 mins/lead, average 14 electrodes). In the SEEG population, there were no revised or unsuccessful seizure localizations. For biopsy, diagnostic tissue was obtained in 100% of cases. For LITT, fiber placement was adequate for ablation in 100% of cases. There were no cases of symptomatic or asymptomatic intracerebral hemorrhage, and no cases required repositioning or replacement of the laser fiber, electrode, or biopsy needle. One patient experienced transient cranial nerve III palsy following laser ablation that resolved in 10 weeks. A failure of communication between the robotic platform and the Stealth Autoguide as a station required the cancellation of 1 procedure.
CONCLUSIONS: The Medtronic Stealth Autoguide robot system is versatile across biopsy, SEEG, and laser ablation indications. Setup and surgical execution are efficient with a high degree of accuracy and consistency.
摘要：
目的：立体定向技术在神经外科中起着重要作用。开发具有高效工作流程和精确手术执行的小型化颅骨机器人是这些技术更广泛应用的重要一步。在这里，作者描述了他们使用美敦力隐形Autoguide小型化颅骨机器人的经验。
方法：对2020年至2022年的75例病例进行回顾性分析。分析了使用StealthAutoguide机器人进行手术的患者的手术适应症和准确性，手术时间,和临床结果。结果定义如下：对于立体脑电图(SEEG)，确定癫痫发作焦点且不需要任何修正或额外引线的电极放置模式；对于活检，获得诊断组织的病例百分比；对于激光间质热疗法（LITT），激光光纤放置足以消融的病例百分比。手术并发症定义为无症状或有症状的脑出血。新的神经缺陷,或需要电极，激光光纤,或活检针重新定位或翻修。
结果：在75个标签上案例中使用了隐形自动引导机器人，包括40例SEEG癫痫病灶定位病例，19LITT案件，立体定向活检16例。活检入口处的平均真实目标误差（RTE）为1.48±0.84mm，1.36±0.89mm，适用于Visualase激光光纤放置，SEEG为1.24±0.72mm。活检针放置时，目标处的平均RTE为1.56±0.95mm，1.42±0.93mm，适用于Visualase激光光纤放置，SEEG电极放置1.31±0.87mm。单侧SEEG病例的手术时间平均为52分钟（平均6.5分钟/导联，平均8个电极)。双侧SEEG病例平均耗时105分钟(平均7.5分钟/铅,平均14个电极)。在SEEG人口中，没有修订或不成功的癫痫发作定位。活检，在100％的病例中获得了诊断组织。对于LITT，在100%的病例中,纤维放置足以进行消融.没有出现有症状或无症状的脑出血，并且不需要重新定位或更换激光光纤的情况，电极,或者活检针.一名患者在激光消融后出现短暂性颅神经III麻痹，并在10周内消退。机器人平台与作为站的隐形自动指南之间的通信失败需要取消1个程序。
结论：MedtronicStealthAutoguide机器人系统在活检中用途广泛，SEEG,和激光消融适应症。设置和手术执行是高效的,具有高度的准确性和一致性。
方法：对2020年至2022年的75例病例进行回顾性分析。分析了使用StealthAutoguide机器人进行手术的患者的手术适应症和准确性，手术时间,和临床结果。结果定义如下：对于立体脑电图(SEEG)，确定癫痫发作焦点且不需要任何修正或额外引线的电极放置模式；对于活检，获得诊断组织的病例百分比；对于激光间质热疗法（LITT），激光光纤放置足以消融的病例百分比。手术并发症定义为无症状或有症状的脑出血。新的神经缺陷,或需要电极，激光光纤,或活检针重新定位或翻修。
结果：在75个标签上案例中使用了隐形自动引导机器人，包括40例SEEG癫痫病灶定位病例，19LITT案件，立体定向活检16例。活检入口处的平均真实目标误差（RTE）为1.48±0.84mm，1.36±0.89mm，适用于Visualase激光光纤放置，SEEG为1.24±0.72mm。活检针放置时，目标处的平均RTE为1.56±0.95mm，1.42±0.93mm，适用于Visualase激光光纤放置，SEEG电极放置1.31±0.87mm。单侧SEEG病例的手术时间平均为52分钟（平均6.5分钟/导联，平均8个电极)。双侧SEEG病例平均耗时105分钟(平均7.5分钟/铅,平均14个电极)。在SEEG人口中，没有修订或不成功的癫痫发作定位。活检，在100％的病例中获得了诊断组织。对于LITT，在100%的病例中,纤维放置足以进行消融.没有出现有症状或无症状的脑出血，并且不需要重新定位或更换激光光纤的情况，电极,或者活检针.一名患者在激光消融后出现短暂性颅神经III麻痹，并在10周内消退。机器人平台与作为站的隐形自动指南之间的通信失败需要取消1个程序。
结论：MedtronicStealthAutoguide机器人系统在活检中用途广泛，SEEG,和激光消融适应症。设置和手术执行是高效的,具有高度的准确性和一致性。
