Robot-assisted stereotactic brainstem biopsy in children: prospective cohort study
Author(s)
Dawes, William
Marcus, Hani J
Tisdall, Martin
Aquilina, Kristian
Type
Journal Article
Abstract
Tumours located within the brainstem comprise approximately a tenth of all paediatric brain tumours. Surgical biopsy of these tumours is technically challenging and has historically been associated with considerable risk. To this end, robot-assisted surgery theoretically allows for increased accuracy and precision. In this study we report our experience using the Neuromate robot (Renishaw, Gloucestershire, UK) to perform robot-assisted stereotactic biopsy in children with tumours located within the brainstem. An uncontrolled prospective cohort study was performed (phase II) according to the IDEAL model for safe surgical innovation. All cases were recorded on a prospectively maintained database. The database was searched over a 2-year period between the 1st December 2015 and the 31st November 2017 to identify all children with brainstem tumours that underwent robot-assisted stereotactic brain biopsy. When accessible, the post-operative MRI scans and pre-operative plans were compared to assess the target point localisation error (TPLE). Adverse events were recorded prospectively according to whether they resulted in increased hospital stay, caused neurological injury, or lead to death. In all, 11 consecutive children were identified with brain tumours located within the brainstem. In 10/11 cases specimens were diagnostic; in the remaining case a further biopsy was successful. The most frequent pathology was DIPG (7/15). Seven patients underwent an early post-operative volumetric MRI; the calculated median TPLE was 2.7 mm (range 0.5-4.2 mm). There were no surgical complications noted. Robot-assisted stereotactic biopsy in children appears to be feasible and safe. Research databases and comparative studies are warranted to further assess the technique.
Date Issued
2019-08-01
Date Acceptance
2018-11-28
Citation
Journal of Robotic Surgery, 2019, 13 (4), pp.575-579
ISSN
1863-2483
Publisher
Springer Verlag
Start Page
575
End Page
579
Journal / Book Title
Journal of Robotic Surgery
Volume
13
Issue
4
Copyright Statement
© 2018 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30523502
PII: 10.1007/s11701-018-0899-x
Subjects
DIPG
Diffuse intrinsic brainstem glioma
Robotics
Stereotaxy
Surgery
Adolescent
Biopsy
Brain Stem
Brain Stem Neoplasms
Child
Child, Preschool
Female
Humans
Magnetic Resonance Imaging
Male
Neuroimaging
Prospective Studies
Robotic Surgical Procedures
Stereotaxic Techniques
Tomography, X-Ray Computed
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2018-12-06