Techniques of Frameless Robot-Assisted Deep Brain Stimulation and Accuracy Compared with the Frame-Based Technique

Background: Frameless robot-assisted deep brain stimulation (DBS) is an innovative technique for leads implantation. This study aimed to evaluate the accuracy and precision of this technique using the Sinovation SR1 robot. Methods: 35 patients with Parkinson’s disease who accepted conventional frame-based DBS surgery (n = 18) and frameless robot-assisted DBS surgery (n = 17) by the same group of neurosurgeons were analyzed. The coordinate of the tip of the intended trajectory was recorded as x(i), y(i), and z(i). The actual position of lead implantation was recorded as xa, ya, and za. The vector error was calculated by the formula of √(x(i) − x(a))(2) + (y(i) − y(a))(2) + (z(i) − z(a))(2) to evaluate the accuracy. Results: The vector error was 1.52 ± 0.53 mm (range: 0.20–2.39 mm) in the robot-assisted group and was 1.77 ± 0.67 mm (0.59–2.98 mm) in the frame-based group with no significant difference between two groups (p = 0.1301). In 10.7% (n = 3) frameless robot-assisted implanted leads, the vector error was greater than 2.00 mm with a maximum offset of 2.39 mm, and in 35.5% (n = 11) frame-based implanted leads, the vector error was larger than 2.00 mm with a maximum offset of 2.98 mm. Leads were more posterior than planned trajectories in the robot-assisted group and more medial and posterior in the conventional frame-based group. Conclusions: Awake frameless robot-assisted DBS surgery was comparable to the conventional frame-based technique in the accuracy and precision for leads implantation.