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MRI-based and robot-assisted stereotactic biopsy with intraoperative CT imaging

  • How I Do it - Brain Tumors
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Abstract

Background

As a pioneer center in the field of stereotaxy, Sainte-Anne school has always advocated the use of intraoperative imaging for stereotactic procedures to optimize both safety and accuracy. With the advent of intraoperative mobile CT unit, the robot-assisted stereotactic biopsy procedure has been recently updated.

Method

Herein, we aim at describing our new surgical procedure that combines robotic assistance (NeuroMate, Renishaw) and intraoperative cone beam CT imaging (O-Arm, Medtronic).

Conclusion

Intraoperative imaging with the O-Arm was efficiently incorporated into the workflow. This new equipment leads to optimizing operative time and an easier realization of intraoperative imaging.

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Funding

This study was funded by the Nuovo-Soldati Foundation for Cancer Research scholarship, the Servier Foundation scholarship, and the Fundapro Foundation scholarship.

Author information

Authors and Affiliations

  1. Service de Neurochirurgie, GHU Paris – Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris Cedex 14, France

    Marc Zanello, Giorgia Antonia Simboli & Johan Pallud

  2. Université de Paris, Paris, France

    Marc Zanello, Giorgia Antonia Simboli & Johan Pallud

  3. Institute of Psychiatry and Neurosciences of Paris, INSERM, UMR 1266, IMA-BRAIN, Paris, France

    Marc Zanello & Johan Pallud

  4. Department of Functional and Stereotactic Neurosurgery, APHM-Timone University Hospital, Marseille, France

    Romain Carron

  5. Institut de Neurosciences Des Systèmes, INSERM, INS, Aix Marseille Université, Marseille, France

    Romain Carron

Authors
  1. Marc Zanello
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  2. Giorgia Antonia Simboli
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  3. Romain Carron
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  4. Johan Pallud
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Corresponding author

Correspondence to Marc Zanello.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Patient consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

10 key points summary

1. Inform the patient about the time required to obtain definitive histomolecular diagnosis.

2. The planning of the stereotactic trajectory is a key step and requires time and attention (the planification is therefore best performed the day prior to surgery and ideally by two neurosurgeons).

3. Robotic assistance has many advantages over frame-based procedures including high mechanical accuracy, and it is less prone to human error (no reading and manual settings of the target coordinates).

4. Intraoperative imaging ensures the highest possible accuracy for a biopsy trajectory and makes it possible to know precisely the sites where the samples are taken for postoperative analyses.

5. General anesthesia precludes any high blood pressure episode.

6. The head should be firmly fixed using a head clamp.

7. Robot tool holder should be approached very close and ideally come in contact with the skin surface when drilling to avoid the potential bending of the drill bit and minimize mechanical inaccuracy.

8. Drilling of the skull should be smooth and slow, followed by coagulation of the dura, and measurement of the biopsy cannula based on the imagery.

9. The biopsy cannula is to be inserted with closed side cutting windows and subsequently opened once in the biopsy site, to perform a minimum of 10-s-long suction in order to obtain biopsy samples of a substantial size.

10. Several biopsy samples from different imaging components of the targeted lesion are to be obtained (the number of biopsy samples is not associated with increased morbidity).

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Zanello, M., Simboli, G.A., Carron, R. et al. MRI-based and robot-assisted stereotactic biopsy with intraoperative CT imaging. Acta Neurochir 164, 3311–3315 (2022). https://doi.org/10.1007/s00701-022-05271-1

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  • DOI: https://doi.org/10.1007/s00701-022-05271-1

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