🧠 Robot-Assisted Deep Brain Stimulation Surgery [Neurosurgery Wiki]

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====== 🧠 Robot-Assisted Deep Brain Stimulation Surgery ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1pabLar0q26IwU3IK4GqRHGPI_-ffuNJB-gNNqTq1vcg7VGkYN/?limit=15&utm_campaign=pubmed-2&fc=20250614063820}}

===== 🔍 Definition =====
[[Robot]]-assisted [[deep brain stimulation]] (DBS) is a [[neurosurgical technique]] where a [[robotic system]] guides the implantation of electrodes into deep brain structures (e.g., subthalamic nucleus, globus pallidus internus) with high precision. It is primarily used to treat movement disorders such as Parkinson’s disease, essential tremor, and dystonia.

===== ⚙️ Key Components =====
^ Component               ^ Description                                                                              ^
| **Surgical Robot**      | Systems like **Neuromate** (Renishaw) or **ROSA** (Zimmer Biomet) provide submillimetric guidance. |
| **Imaging Integration** | Intraoperative **cone-beam CT** (e.g., Medtronic O-Arm) or **MRI** allows real-time verification.   |
| **Frameless Registration** | Devices like **NeuroLocate** enable accurate registration without a rigid stereotactic frame.    |
| **Planning Software**   | Preoperative fusion of high-resolution MRI and CT scans allows accurate trajectory planning.        |

===== ✅ Advantages =====
  * High targeting accuracy (submillimetric)
  * Reduced surgical time
  * Reproducible workflow
  * Frameless system increases patient comfort
  * Real-time electrode verification with imaging

===== ⚠️ Limitations =====
  * High cost of equipment and maintenance
  * Steep learning curve for the surgical team
  * Limited clinical evidence of superiority over frame-based methods
  * Potential overreliance on technology instead of surgical expertise

===== 📊 Current Evidence =====
^ Study Type      ^ General Findings                                                           ^
| Case Series     | Improved workflow and technical precision                                   |
| Comparative     | Mixed outcomes; minor advantages over traditional methods in some reports   |
| Meta-Analyses   | Limited by heterogeneity and lack of high-quality randomized trials         |

===== 🧠 Common Targets =====
  * Subthalamic Nucleus (STN)
  * Globus Pallidus Internus (GPi)
  * Ventral Intermediate Nucleus of the Thalamus (VIM)

===== 🏥 Clinical Indications =====
  * Advanced Parkinson’s disease, refractory to medication
  * Disabling essential tremor
  * Primary dystonia
  * Investigational use in refractory OCD and Tourette syndrome

===== 📌 Conclusion =====
Robot-assisted DBS is a technologically advanced alternative to traditional frame-based stereotaxy. It offers enhanced accuracy and intraoperative imaging verification, but **does not yet have strong evidence to support clinical superiority**. It is a **promising tool**, but **not a new gold standard—yet**.

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Ho et al. first report of application of [[frameless]] robotic-assistance with the Mazor Renaissance platform ([[Mazor Robotics]] Ltd, Caesarea, [[Israel]]) for DBS surgery, and the findings revealed that an initial experience is safe and can have a positive impact on operative efficiency, accuracy, and safety
((Ho AL, Pendharkar AV, Brewster R, Martinez DL, Jaffe RA, Xu LW, Miller KJ, Halpern CH. Frameless Robot-Assisted Deep Brain Stimulation Surgery: An Initial Experience. Oper Neurosurg (Hagerstown). 2019 Oct 1;17(4):424-431. doi: 10.1093/ons/opy395. PMID: 30629245.)).
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Robot-assisted stereotactic implantation of DBS electrodes in the pediatric age group is a safe and accurate surgical method. Greater accuracy was present in the cohort of Furlanetti et al. in comparison to previous studies in which conventional stereotactic frame-based techniques were used. Robotic DBS surgery and neuroradiological advances may result in further improvement in surgical targeting and, consequently, in better clinical outcome in the pediatric population
((Furlanetti L, Ellenbogen J, Gimeno H, Ainaga L, Narbad V, Hasegawa H, Lin JP, Ashkan K, Selway R. Targeting accuracy of robot-assisted deep brain stimulation surgery in childhood-onset dystonia: a single-center prospective cohort analysis of 45 consecutive cases. J Neurosurg Pediatr. 2021 Apr 16:1-11. doi: 10.3171/2020.10.PEDS20633. Epub ahead of print. PMID: 33862592.)).

===== Robot-Assisted Deep Brain Stimulation for Parkinson's disease =====
 
[[Robot-Assisted Deep Brain Stimulation for Parkinson's disease]].

===== Technical Notes =====

In a [[technical note]] Defrance et al. from the Hôpital Sainte-Anne, [[Paris]], [[France]], detail the current surgical [[workflow]] for [[DBS]] [[implantation]], combining the [[Neuromate]] robot ([[Renishaw]]), the [[NeuroLocate]] frameless registration module, and intraoperative cone-beam CT imaging using the [[O-Arm]] system (Medtronic).

They conclude that this approach provides a safe, efficient, and reproducible alternative to traditional methods, supporting its broader adoption in modern functional neurosurgery
((Defrance G, Domenech P, Pallud J, Zanello M. Robot-assisted deep brain stimulation with intraoperative CT imaging and frameless registration module: a new gold-standard? Acta Neurochir (Wien). 2025 Jun 13;167(1):168. doi: 10.1007/s00701-025-06581-w. PMID: 40512288.)).
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===== 📄 Type of Study =====
  * Descriptive technical [[workflow]]
  * No [[patient data]], [[outcome]]s, or [[comparative metrics]]
  * Level V evidence ([[expert opinion]])
  * Not a [[clinical study]]

===== ⚠️ Major Concerns =====

==== ❌ 1. No Clinical Data ====
  * No series, no [[operative time metrics]], no outcome rates
  * No comparison to frame-based DBS
  * Fails to provide even basic targeting accuracy

==== ❌ 2. Misleading “Gold-Standard” Claim ====
  * The title implies validated superiority without presenting data
  * Contradicts multiple studies showing equivalence—not superiority—of robotic DBS

==== ❌ 3. Lack of Technical Depth ====
  * Ignores critical issues:
    - [[Frameless]] registration errors
    - [[Brain shift]] and intraoperative movement
    - [[Imaging fusion]] challenges
  * Offers no [[troubleshooting]] or [[limitation]]s of [[device]]s

==== ❌ 4. No Comparative Context ====
  * No mention of existing [[accuracy]] data from frame-based or [[robotic system]]s
  * Omits findings from [[peer-review]]ed robotic DBS studies (e.g., targeting errors ~1.0 mm)

==== ❌ 5. Weak Evidence Tier ====
  * No [[hypothesis]]
  * No [[method]]s section fitting [[Evidence-Based Medicine]] [[Standard]]s
  * Unqualified as research—best categorized as a surgical [[protocol]] [[note]]

==== ❌ 6. Opaque Conflicts of Interest ====
  * Promotes commercial technologies (Renishaw, Medtronic)
  * No [[financial disclosure]]s
  * Strong appearance of **[[industry bias]]**

===== 📊 Reality Check Table =====
^ CLAIM                                ^ REALITY                                                                 ^
| "New gold standard"                 | No supporting data or trials                                             |
| "Improved accuracy & safety"       | No statistical evidence or patient outcomes provided                     |
| "Efficient & reproducible workflow" | Not benchmarked against traditional methods                             |
| "Justifies broader adoption"       | No cost analysis, no risk-benefit assessment, no follow-up data         |

===== 🧨 Final Verdict =====
This article is a **thinly veiled promotional piece**, dressed as peer-reviewed science.  
It lacks data, ignores known challenges, and inflates its claims beyond justification.

**It should have been published as a [[Technical Note]]—not an article—if at all.**  
A cautionary example of how **[[academic journal]]s can become conduits for commercial evangelism** under the guise of [[innovation]].