Two-year clinical outcomes associated with robotic-assisted subthalamic lead implantation in patients with Parkinson's disease

J Robot Surg. 2020 Aug;14(4):559-565. doi: 10.1007/s11701-019-01025-x. Epub 2019 Sep 13.

Abstract

Few centers have routinely implemented robotic stereotactic systems for deep brain stimulator (DBS) placement. The present study compares clinical outcomes associated with robotic-assisted subthalamic nucleus (STN)-targeted DBS surgery in patients with Parkinson's disease (PD) to those of the traditional frame-based method. A retrospective chart review was performed (February 2013-June 2017). Thirty-three patients were implanted using the Cosman-Roberts-Wells (CRW) frame and 27 patients were implanted using the ROSA robot. Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) or UPDRS part III motor scores and levodopa equivalent daily doses (LEDD) were examined preoperatively and at 6, 12, and 24 months of follow-up. Operative times and complication rates were recorded. For the frame-based group, the reduction in the mean MDS-UPDRS part III motor score compared to baseline was 27% both at 6 and 12 months, and 36.7% at 24 months. For the robotic-assisted group, the reduction in the mean motor score from baseline was 17.6% at 6 months, 19% at 12 months and 21.4% at 24 months. The mean LEDD for the frame-based group decreased by 48.7% at 6 months, 56.7% at 12 months, and 29.7% at 24 months. For the robotic-assisted group, the mean LEDD decreased by 42% at 6 months, 45% at 12 months and 50% at 24 months. There were no significant differences in the mean motor scores and the LEDD reduction between the two groups. Operative times tended to be longer for robotic-assisted DBS surgery. Clinical outcomes associated with robotic-assisted surgery are comparable to those with frame-based surgery.

Keywords: Deep brain stimulation; Movement disorders; Parkinson’s disease; STN-targeted DBS; Stereotactic neurosurgery; Surgical robotics.

MeSH terms

  • Aged
  • Deep Brain Stimulation / instrumentation*
  • Electrodes, Implanted*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures / methods*
  • Operative Time
  • Parkinson Disease / surgery*
  • Postoperative Complications / epidemiology
  • Prosthesis Implantation / methods*
  • Retrospective Studies
  • Robotic Surgical Procedures / methods*
  • Stereotaxic Techniques*
  • Subthalamic Nucleus / surgery*
  • Time Factors
  • Treatment Outcome