Deep brain stimulation (DBS) is an established treatment for pediatric dystonia. The accuracy of electrode implantation is multifactorial and remains a challenge in this age group, mainly due to smaller anatomical targets in very young patients compared to adults, and also due to anatomical abnormalities frequently associated with some etiologies of dystonia. Data on the accuracy of robot-assisted DBS surgery in children are limited. The aim of the current paper was to assess the accuracy of robot-assisted implantation of DBS leads in a series of patients with childhood-onset dystonia.

Forty-five children with dystonia undergoing implantation of DBS leads under general anesthesia between 2017 and 2019 were included. Robot-assisted stereotactic implantation of the DBS leads was performed. The final position of the electrodes was verified with an intraoperative 3D scanner (O-arm). Coordinates of the planned electrode target and actual electrode position were obtained and compared, looking at the radial error, depth error, absolute error, and directional error, as well as the euclidean distance. Functional assessment data prospectively collected by a multidisciplinary pediatric complex motor disorders team were analyzed with regard to motor skills, individualized goal achievement, and patients’ and caregivers’ expectations.

A total of 90 DBS electrodes were implanted and 48.5% of the patients were female. The mean age was 11.0 ± 0.6 years (range 3–18 years). All patients received bilateral DBS electrodes into the globus pallidus internus. The median absolute errors in x-, y-, and z-axes were 0.85 mm (range 0.00–3.25 mm), 0.75 mm (range 0.05–2.45 mm), and 0.75 mm (range 0.00–3.50 mm), respectively. The median euclidean distance from the target to the actual electrode position was 1.69 ± 0.92 mm, and the median radial error was 1.21 ± 0.79. The robot-assisted technique was easily integrated into the authors’ surgical practice, improving accuracy and efficiency, and reducing surgical time significantly along the learning curve. No major perioperative complications occurred.

Robot-assisted stereotactic implantation of DBS electrodes in the pediatric age group is a safe and accurate surgical method. Greater accuracy was present in this cohort in comparison to previous studies in which conventional stereotactic frame-based techniques were used. Robotic DBS surgery and neuroradiological advances may result in further improvement in surgical targeting and, consequently, in better clinical outcome in the pediatric population.

深部脑刺激 (DBS) 是治疗小儿肌张力障碍的成熟疗法。电极植入的准确性是多因素的，并且在这个年龄组中仍然是一个挑战，主要是由于与成人相比，非常年轻的患者的解剖目标较小，并且还由于解剖异常经常与某些肌张力障碍病因相关。关于机器人辅助 DBS 手术在儿童中的准确性的数据有限。本论文的目的是评估机器人辅助植入 DBS 导线在一系列儿童期肌张力障碍患者中的​​准确性。

纳入 2017 年至 2019 年间在全身麻醉下进行 DBS 导线植入的 45 名肌张力障碍儿童。进行了 DBS 导线的机器人辅助立体定向植入。使用术中 3D 扫描仪（O 型臂）验证电极的最终位置。获得并比较计划电极目标和实际电极位置的坐标，查看径向误差、深度误差、绝对误差和方向误差，以及欧氏距离。由多学科儿科复杂运动障碍团队前瞻性收集的功能评估数据在运动技能、个性化目标实现以及患者和护理人员的期望方面进行了分析。

共植入 90 个 DBS 电极，48.5% 的患者为女性。平均年龄为 11.0 ± 0.6 岁（范围 3-18 岁）。所有患者都将双侧 DBS 电极插入苍白球内部。x 轴、y 轴和 z 轴的中值绝对误差分别为 0.85 毫米（范围 0.00-3.25 毫米）、0.75 毫米（范围 0.05-2.45 毫米）和 0.75 毫米（范围 0.00-3.50 毫米）。从目标到实际电极位置的欧氏距离中位数为 1.69 ± 0.92 mm，径向误差中位数为 1.21 ± 0.79。机器人辅助技术很容易集成到作者的手术实践中，提高了准确性和效率，并沿着学习曲线显着减少了手术时间。围手术期未发生重大并发症。

机器人辅助 DBS 电极立体定向植入术是一种安全、准确的手术方法。与之前使用传统立体定向框架技术的研究相比，该队列的准确性更高。机器人 DBS 手术和神经放射学的进步可能会进一步改善手术靶向性，从而改善儿科人群的临床结果。