Robot-Assisted Deep Brain Stimulation: High Accuracy and Streamlined Workflow

Nisha Giridharan, Kalman Katlowitz, Adrish Anand, Ron Gadot, Ricardo A. Najera, Ben Shofty, Rita Snyder, Christopher Larrinaga, Marc Prablek, Patrick J. Karas, Ashwin Viswanathan, Sameer A. Sheth

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


BACKGROUND: A number of stereotactic platforms are available for performing deep brain stimulation (DBS) lead implantation. Robot-assisted stereotaxy has emerged more recently demonstrating comparable accuracy and shorter operating room times compared with conventional frame-based systems. OBJECTIVE: To compare the accuracy of our streamlined robotic DBS workflow with data in the literature from frame-based and frameless systems. METHODS: We retrospectively reviewed 126 consecutive DBS lead placement procedures using a robotic stereotactic platform. Indications included Parkinson disease (n = 94), essential tremor (n = 21), obsessive compulsive disorder (n = 7), and dystonia (n = 4). Procedures were performed using a stereotactic frame for fixation and the frame pins as skull fiducials for robot registration. We used intraoperative fluoroscopic computed tomography for registration and postplacement verification. RESULTS: The mean radial error for the target point was 1.06 mm (SD: 0.55 mm, range 0.04-2.80 mm) on intraoperative fluoroscopic computed tomography. The mean operative time for an asleep, bilateral implant without implantable pulse generator placement was 238 minutes (SD: 52 minutes), and skin-to-skin procedure time was 116 minutes (SD: 42 minutes). CONCLUSION: We describe a streamlined workflow for DBS lead placement using robot-assisted stereotaxy with a comparable accuracy profile. Obviating the need for checking and switching coordinates, as is standard for frame-based DBS, also reduces the chance for human error and facilitates training.

Original languageEnglish (US)
Pages (from-to)254-260
Number of pages7
JournalOperative Neurosurgery
Issue number3
StatePublished - Sep 14 2022
Externally publishedYes


  • Accuracy
  • Deep brain stimulation
  • Robot-assisted stereotaxy

ASJC Scopus subject areas

  • General Medicine


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