| Background of the study:Deep brain electrical stimulation(DBS)is currently the treatment of choice for patients with intermediate to advanced Parkinson’s disease.DBS surgery requires a very high degree of precision,and improving the accuracy of electrode implantation and avoiding errors in implantation are key surgical points for the success or failure of the procedure and the prognosis of the patient.In the past,DBS surgery relied heavily on stereotactic frames for target localisation,but the frame system itself had errors,and human manipulation also produced certain errors,which to a certain extent limited the further development of DBS precision.Recent years have seen rapid advances in artificial intelligence and the use of robotics in functional neurosurgery to overcome some of the human factors that limit the accuracy of DBS,but no difference has yet been seen in the accuracy of robotic-assisted and stereotactic frameworks for implanting electrodes in DBS,especially with the accuracy of a domestic robot(Sinovation)in surgery.In order to maximise treatment efficacy and minimise side effects,and to achieve optimal control of patients’ clinical symptoms,it is important to compare the accuracy of the domestic robot-assisted and Leksell frame systems in deep brain electrical stimulation for clinicians to choose the best procedure.The Leksell frame system has been used in the early stages of surgery in our unit,and robotic surgery has been successfully performed in the last two years,accumulating a certain number of case histories.Objective:The aim of this study was to compare and investigate the differences in the accuracy of robotic(Waco Precision)assisted and stereotactic frame-assisted DBS implantation electrodes,as well as to analyse the rate of improvement in clinical symptoms and the incidence of adverse effects in patients with different surgical approaches,to clarify the value of surgical robots in clinical applications,and also to provide a reliable reference for clinicians in choosing the optimal procedure.Methods:The clinical data of 20 patients with Parkinson’s disease who attended the First Affiliated Hospital of Henan University and underwent DBS surgery from March 2019 to October 2022 were retrospectively studied.Among them,12(60.0%)were male and 8(40.0%)were female.The age was 45-67 years,with a mean of(58.55± 6.78)years.The preoperative disease duration ranged from 5-10 years,with a median duration of 8 years.Hoehn-Yahr scores were mostly on a scale of 3-5,with 3 on a scale of 3,10 on a scale of 4 and 7 on a scale of 5.After a rigorous preoperative assessment,all patients underwent preoperative3.0T high-resolution magnetic resonance imaging.Patients were divided into Leksell and robotic surgery groups according to the surgical approach taken,and the implanted electrodes were divided into designed and actual target sites.The incidence of adverse effects was calculated.The aim was to identify the best surgical approach for patients undergoing DBS.Results:1.Both groups completed electrode implantation in one go,with a total of 40 electrodes implanted,and there was no need to adjust the electrode position.2.In terms of electrode implantation accuracy,according to the statistical results,the corresponding data of the robotic group in the X-axis and Z-axis were compared with P 0.450 and 0.321,respectively,which were greater than 0.05 and not statistically different,indicating that the robotic surgery for target nucleus electrode implantation was very close to the designed target in the X-and Z-axis,but P < 0.05 in the Y-axis,which was statistically different,indicating that the robotic group had some error in Y-axis positioning There was some error in the Y-axis positioning of the robotic group.The mean target error in the robotic group 1.34 ± 0.53 mm was less than that in the Leksell frame group 1.89 ± 1.44 mm,and the precision error in the implantation target in the robotic surgery group was less than that in the Leksell group.3.There was no statistically significant difference in the rate of improvement in UPDRS-III motor scores at each follow-up node between the two groups of patients comparing pre-surgery and post-op.4.In terms of operative time,the robotic group had a statistically significant difference with less operative time than the Leksell frame group and less electrode implantation time than the frame group.5.In terms of LEDD improvement rate,no significant difference was seen between the two groups of patients at 1 year post-operative follow-up6.No surgery-related complications were seen in the two groups of patients at post-operative and1-year post-operative follow-up.Conclusions:1.the efficacy of DBS surgery in patients with intermediate to advanced PD is significant;2.By comparing the clinical data of DBS surgery under the Leksell stereotactic framework with robotic(Sinovation)DBS surgery,it is clear that Sinovation surgical robot-assisted DBS surgery is safe and precise,has significant advantages over the Leksell framework in terms of precision,can achieve the same efficacy as traditional stereotactic framework surgery,and has a significant reduction in operative time compared with the framework The DBS procedure is a safe and precise procedure with significant advantages over the Leksell frame in terms of precision. |
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