🧠 Robot-Assisted Deep Brain Stimulation Surgery

• Robot-assisted deep brain stimulation with intraoperative CT imaging and frameless registration module: a new gold-standard?
• A systematic review and meta-analysis of robot-assisted deep brain stimulation: comparative insights with conventional techniques
• Utilization of Intraoperative Navigation in Stereotactic Neurosurgery
• Stereotactic robot-assisted MRI-guided laser interstitial thermal therapy thalamotomy for medically intractable Holmes tremor: a pilot study and literature review
• Safety and efficiency of deep brain stimulation in the elderly patients with Parkinson's disease
• Efficacy and safety of robot-assisted deep brain stimulation for Parkinson's disease: a meta-analysis
• Unilateral deep brain stimulation (DBS) of nucleus ventralis intermedius thalami (Vim) for the treatment of post-traumatic tremor in children: a multicentre experience
• Evaluation of 3D C-Arm Fluoroscopy versus Diagnostic CT for Deep Brain Stimulation Stereotactic Registration and Post-Operative Lead Localization

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.

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

• 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

• Subthalamic Nucleus (STN)
• Globus Pallidus Internus (GPi)
• Ventral Intermediate Nucleus of the Thalamus (VIM)

• Advanced Parkinson’s disease, refractory to medication
• Disabling essential tremor
• Primary dystonia
• Investigational use in refractory OCD and Tourette syndrome

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.

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 ¹⁾.

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 ²⁾.

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

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 ³⁾.

• Descriptive technical workflow
• No patient data, outcomes, or comparative metrics
• Level V evidence (expert opinion)
• Not a clinical study

• No series, no operative time metrics, no outcome rates
• No comparison to frame-based DBS
• Fails to provide even basic targeting accuracy

• The title implies validated superiority without presenting data
• Contradicts multiple studies showing equivalence—not superiority—of robotic DBS

• Ignores critical issues:
  1. Frameless registration errors
  2. Brain shift and intraoperative movement
  3. Imaging fusion challenges
• Offers no troubleshooting or limitations of devices

• No mention of existing accuracy data from frame-based or robotic systems
• Omits findings from peer-reviewed robotic DBS studies (e.g., targeting errors ~1.0 mm)

• No hypothesis
• No methods section fitting Evidence-Based Medicine Standards
• Unqualified as research—best categorized as a surgical protocol note

• Promotes commercial technologies (Renishaw, Medtronic)
• No financial disclosures
• Strong appearance of industry bias

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 journals can become conduits for commercial evangelism under the guise of innovation.