Neuro-oncology application of next-generation, optically tracked robotic stereotaxis with intraoperative computed tomography: a pilot experience

OBJECTIVE Innovations in robotics continue to reshape the landscape of neurosurgery. Here, the authors evaluated the safety and efficacy of the ExcelsiusGPS robot in the treatment of neuro-oncological, intracranial lesions. METHODS The authors conducted a retrospective analysis of 19 consecutive adult patients with a neuro-oncological diagnosis who underwent intracranial biopsy and/or laser interstitial thermal therapy (LITT) with the assistance of the ExcelsiusGPS robot and intraoperative CT. Demographic and clinical data were collected from the electronic medical record and the robot software. RESULTS All 19 patients harbored lesions that were deep seated, involving the eloquent cortex, or subcentimeter. Definitive tissue diagnosis was achieved in all cases involving stereotactic biopsy (n = 16), with glioblastoma as the most common diagnosis. The mean ± SD time for setting up the robotic stereotaxis system was 57.4 ± 10.7 minutes. The mean procedural time after that was 71.6 ± 41.0 minutes for stereotactic needle biopsy and 188.4 ± 61.2 minutes for procedures involving LITT. The mean radial errors of the actual trajectory relative to the planned trajectory at the entry and target points were 0.625 ± 0.443 mm and 0.745 ± 0.472 mm, respectively. There were no procedural complications or new postoperative deficits, although routine postoperative CT showed new hyperdensity at the target site in 3/19 patients (15.7%). All patients who underwent elective procedures were discharged by postoperative day 3 (mean 1.38 ± 0.619 days). There were two 30-day readmissions (pulmonary embolus and general weakness), and neither was attributable to the surgical procedure. CONCLUSIONS The authors’ pilot experience with the ExcelsiusGPS robot in neuro-oncology procedures indicates a favorable efficacy and safety profile.