Robot-assisted stereotactic brainstem biopsy in children: prospective cohort study.
William DawesHani J MarcusMartin TisdallKristian AquilinaPublished in: Journal of robotic surgery (2018)
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.
Keyphrases
- robot assisted
- minimally invasive
- young adults
- fine needle aspiration
- ultrasound guided
- clinical trial
- magnetic resonance imaging
- resting state
- emergency department
- phase ii
- healthcare
- small cell lung cancer
- computed tomography
- intensive care unit
- white matter
- magnetic resonance
- functional connectivity
- acute coronary syndrome
- health insurance
- blood brain barrier
- study protocol
- patient reported
- coronary artery disease
- diffusion weighted imaging
- big data