目的:机器人辅助活检在过去几年中越来越受欢迎。大多数机器人程序是用基于地板的机械臂执行的。最近,美敦力隐形汽车指南,与光学神经导航系统一起工作的小型化机械臂,已发射。其在儿科病例中的应用相对未被探索。在这项研究中,我们回顾性地报告了我们使用隐形导游的经验,用于儿科患者的无框立体定向活检。
方法:本研究包括2020年7月至2023年5月使用StealthAutoguide颅骨机器人平台进行立体定向活检的儿科患者。临床,神经放射学,外科,收集和分析组织学数据。
结果:19例患者接受了20次手术(平均年龄为9岁,范围1-17)。在四名患者中,活检是更复杂的外科手术(激光间质热疗法-LITT)的一部分.最常见的适应症是弥漫性内在脑干肿瘤,其次是弥漫性幕上肿瘤。在俯卧位进行了九次手术,八位仰卧位,和三个在横向位置。在六个程序中采用了面部表面注册,颅骨固定基准点14.仅接受活检的患者的活检诊断组织获取率为100%,而在活检/LITT组中,有一例未诊断。没有患者出现临床相关的术后并发症。
结论:隐形自动引导系统已被证明是安全的,诊断,在小儿人群中对幕上和幕下病变进行立体定向活检时,具有很高的准确性。
OBJECTIVE: 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.
CONCLUSIONS: 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.