Early Experiences with Robotic-assisted Implantation of Deep Brain Stimulation Electrodes in Awake or Asleep Patients in Japan

This study evaluated 14 patients who underwent robot-assisted deep brain stimulation electrode implantation and described our early experiences and workflows in both awake and asleep states. The deep brain stimulation targets included the subthalamic nucleus (n = 6), anterior thalamic nucleus (n = 5), and globus pallidus internus (n = 3). The patient was placed in the supine position, and the ROSA system was affixed diagonally onto the Leksell head frame to align with the X-ray system. Registration was performed at the center of each Leksell pin opening. In some patients with globus pallidus internus-deep brain stimulation, we performed semi-microelectrode recording to confirm the inferior border of the globus pallidus internus even under general anesthesia. In all patients with subthalamic nucleus-deep brain stimulation, semi-microelectrode recording was used to confirm the subthalamic nucleus location under local and intravenous anesthesia. In patients with anterior thalamic nucleus-deep brain stimulation, we used several methods for burr holes to avoid cerebrospinal fluid leakage as much as possible because of the trajectories running through the lateral ventricles. Deep brain electroencephalography was performed after the electrodes were inserted into the anterior thalamic nucleus. Deep brain stimulation implantation using the ROSA system was performed smoothly without any trouble in all patients. No intraoperative complications or major complications were reported immediately after deep brain stimulation. This study represents the first reported experience with ROSA-assisted deep brain stimulation in Japan and supports its broader application in awake or asleep state, and with or without semi-microelectrode recording.