Robot-Assisted Stereotaxy Reduces Target Error: A Meta-Analysis and Meta-Regression of 6056 Trajectories.
Publication/Presentation Date
1-13-2021
Abstract
BACKGROUND: The pursuit of improved accuracy for localization and electrode implantation in deep brain stimulation (DBS) and stereoelectroencephalography (sEEG) has fostered an abundance of disparate surgical/stereotactic practices. Specific practices/technologies directly modify implantation accuracy; however, no study has described their respective influence in multivariable context.
OBJECTIVE: To synthesize the known literature to statistically quantify factors affecting implantation accuracy.
METHODS: A systematic review and meta-analysis was conducted to determine the inverse-variance weighted pooled mean target error (MTE) of implanted electrodes among patients undergoing DBS or sEEG. MTE was defined as Euclidean distance between planned and final electrode tip. Meta-regression identified moderators of MTE in a multivariable-adjusted model.
RESULTS: A total of 37 eligible studies were identified from a search return of 2,901 potential articles (2002-2018) - 27 DBS and 10 sEEG. Random-effects pooled MTE = 1.91 mm (95% CI: 1.7-2.1) for DBS and 2.34 mm (95% CI: 2.1-2.6) for sEEG. Meta-regression identified study year, robot use, frame/frameless technique, and intraoperative electrophysiologic testing (iEPT) as significant multivariable-adjusted moderators of MTE (P < .0001, R2 = 0.63). Study year was associated with a 0.92-mm MTE reduction over the 16-yr study period (P = .0035), and robot use with a 0.79-mm decrease (P = .0019). Frameless technique was associated with a mean 0.50-mm (95% CI: 0.17-0.84) increase, and iEPT use with a 0.45-mm (95% CI: 0.10-0.80) increase in MTE. Registration method, imaging type, intraoperative imaging, target, and demographics were not significantly associated with MTE on multivariable analysis.
CONCLUSION: Robot assistance for stereotactic electrode implantation is independently associated with improved accuracy and reduced target error. This remains true regardless of other procedural factors, including frame-based vs frameless technique.
Volume
88
Issue
2
First Page
222
Last Page
233
ISSN
1524-4040
Published In/Presented At
Philipp, L. R., Matias, C. M., Thalheimer, S., Mehta, S. H., Sharan, A., & Wu, C. (2021). Robot-Assisted Stereotaxy Reduces Target Error: A Meta-Analysis and Meta-Regression of 6056 Trajectories. Neurosurgery, 88(2), 222–233. https://doi.org/10.1093/neuros/nyaa428
Disciplines
Medicine and Health Sciences
PubMedID
33045739
Department(s)
Department of Surgery
Document Type
Article
