Robotic arm vs. Stereotactic Frame in Deep Brain Stimulation Surgery for Movement Disorders: A Retrospective Cohort Study

Background: Recently, robotic arms have been incorporated into electrodes for deep brain stimulation (DBS). Objectives: This study aimed to determine the accuracy of brain electrode placement, initial clinical efficacy, and safety profile of the robotic arm Neuromate (Renishaw) compared to a stereotactic frame in movement disorders. Methods: This study involved two retrospective cohorts: one patient was operated on using a stereotactic frame and the other with a robotic arm. This study was conducted at Barcelona Hospital Clinic. Results: Seventy-seven patients were included, of whom 30 underwent surgery using the robot and 47 using a stereotactic frame. There was a significant improvement in the anatomical-radiological accuracy of brain electrode implantation assisted by the robotic arm, measured using radial error (robot: 1.01 ± 0.5 mm vs. frame: 1.32 ± 0.6 mm, P: 0.03). The postoperative improvement percentage of the Unified Parkinson’s Disease Rating Scale at 3 months was similar in both groups (robot: 71.4 ± 18 vs. frame: 72.6% ± 17, P: 0.82). There were no significant differences in the perioperative complications (robot: 4% vs. frame: 4.3%, P: 0.93) or in the adverse reactions related to brain stimulation and medical treatment (robot: 18% vs. frame: 25%, P: 0.53). Conclusions: The use of the robotic arm Neuromate improved the anatomical-radiological accuracy in the placement of DBS electrodes for movement disorders compared with the stereotactic frame. Both systems (robotic and stereotactic frame) exhibited similar initial clinical efficacies and safety profiles.