• Hamzah Yasin, Hans-Joachim Hoff, Ingmar Blümcke, and Matthias Simon.
• Department of Neurosurgery, Bethel Clinic, Bielefeld, Germany.
• World Neurosurg. 2019 Mar 1; 123: e450-e456.

ObjectiveStereotactic biopsy is a standard procedure in neurosurgery. In addition to or even replacing frame-based stereotaxy, some centers also use frameless imaging-based techniques and more recently robotic systems. Here we report a retrospective analysis of our experience with 102 consecutive biopsies performed in our institution using the neuromate robotic device.MethodsBetween March 2013 and April 2018, 102 robot-assisted frameless biopsies were performed in 100 consecutive patients (median age/range: 66/7-86 years, male: 64). Target lesions were deep-seated (insula, basal ganglia, thalamus, midbrain, cerebellar peduncle) in 29 (28.4%) and/or small (<15 mm) in 24 (23.5%) cases. We retrospectively analyzed the histopathologic results as well as complications and the duration of the procedures.ResultsA definite histologic diagnosis could be established in 94 of 102 procedures (92.2%; 94/100 patients = 94.0%), including 67 glial and glioneuronal tumors, 16 central nervous system lymphomas, 7 metastases, 1 primitive neuroectodermal tumor, and 5 cases with inflammatory or infectious disorders. There were no infectious complications. A total of 13 cases (12.7%) suffered from biopsy-related hemorrhages >10 mm; however, persistent surgery-related neurologic worsening was seen in only 3 (2.9%). The average operating time was 10 minutes for placement of the localizing device under local anesthesia and 30 minutes for the actual biopsy procedure.ConclusionsRobot-assisted fameless stereotactic biopsies using the neuromate robot are an alternative to frame-based stereotaxy with a similar diagnostic yield and comparable complication rates.Copyright © 2018 Elsevier Inc. All rights reserved.

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