Neurosurgeon HOAG Newport Beach, California, United States
Introduction: Stereotactic technique development of a miniaturized cranial robot with efficient workflow and accurate surgical execution is important. Here we described the initial US experience with the Medtronic Stealth Autoguide(™) miniaturized cranial robot.
Methods: A retrospective review of 75 cases was performed from 2020- 2022. The patients underwent surgery utilizing the Stealth Autoguide(™) robot were analyzed for surgical indication, accuracy, operative time and clinical outcome. Outcomes were defined as follows: For SEEG placement, electrode placement pattern which identified the seizure focus and did not require any revision or additional leads; for biopsy, percentage of cases in which diagnostic tissue was obtained; for LITT, percentage of cases in laser fiber placement was adequate for ablation. Surgical complications were defined as any asymptomatic or symptomatic intracerebral hemorrhage, new neurological deficit, or need for repositioning or revision.
Results: The Stealth Autoguide(™) robot was utilized in 75 cases, all of which were on-label indications. This included 40 patients who underwent SEEG placement for seizure focus localization, 19 patients who underwent placement of laser fiber for laser interstitial thermal therapy, and 16 patients who underwent stereotactic biopsy. The average RTE at entry was 1.48 +/- 0.84 for biopsy, 1.36 +/- 0.89 for Visualase laser fiber placement, and 1.24 +/- 0.72 for SEEG. The average RTE at target was 1.56 +/- 0.95 for biopsy, 1.42 +/- 0.93 for Visualase laser fiber placement, and 1.31 +/- 0.87 for SEEG. Surgical time for Unilateral SEEG case on average took 52 minutes with an average of 6.5 minutes per lead (avg. 8 electrodes). Bilateral SEG cases on average took 105 minutes with an average of 7.5 minutes per lead (avg. 14 electrodes). Diagnostic tissue was obtained in 100% of cases. The laser fiber placement was adequate position for ablation in 100% of cases.
Conclusion : The Medtronic The Stealth Autoguide(™) robot system is versatile across biopsy, SVG, and laser ablation indications. Set up and surgical execution is efficient with a high degree of accuracy and consistency.