Two-year clinical outcomes associated with robotic-assisted subthalamic lead implantation in patients with Parkinson’s disease

  • Michelle Paff
  • Alice S. WangEmail author
  • Nicolas Phielipp
  • Sumeet Vadera
  • Anna Morenkova
  • Neal Hermanowicz
  • Frank P. K. Hsu
Original Article


Few centers have routinely implemented robotic stereotactic systems for deep brain stimulator (DBS) placement. The present study compares clinical outcomes associated with robotic-assisted subthalamic nucleus (STN)-targeted DBS surgery in patients with Parkinson’s disease (PD) to those of the traditional frame-based method. A retrospective chart review was performed (February 2013–June 2017). Thirty-three patients were implanted using the Cosman–Roberts–Wells (CRW) frame and 27 patients were implanted using the ROSA robot. Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) or UPDRS part III motor scores and levodopa equivalent daily doses (LEDD) were examined preoperatively and at 6, 12, and 24 months of follow-up. Operative times and complication rates were recorded. For the frame-based group, the reduction in the mean MDS-UPDRS part III motor score compared to baseline was 27% both at 6 and 12 months, and 36.7% at 24 months. For the robotic-assisted group, the reduction in the mean motor score from baseline was 17.6% at 6 months, 19% at 12 months and 21.4% at 24 months. The mean LEDD for the frame-based group decreased by 48.7% at 6 months, 56.7% at 12 months, and 29.7% at 24 months. For the robotic-assisted group, the mean LEDD decreased by 42% at 6 months, 45% at 12 months and 50% at 24 months. There were no significant differences in the mean motor scores and the LEDD reduction between the two groups. Operative times tended to be longer for robotic-assisted DBS surgery. Clinical outcomes associated with robotic-assisted surgery are comparable to those with frame-based surgery.


Deep brain stimulation Parkinson’s disease Surgical robotics Stereotactic neurosurgery Movement disorders STN-targeted DBS 


Author contributions

MP collected and analyzed all data, wrote and organized the manuscript, and prepared all tables. ASW assisted with literature searches and manuscript writing. NP, AM, and NH performed patient clinical assessments and managed symptom treatment. NP provided instruction for analyzing clinical data. NP, AM, and NH critically reviewed the manuscript. SV assisted with computing the accuracy of ROSA-assisted DBS lead implantation. FPKH performed all DBS surgeries, critically reviewed and contributed to the manuscript.



Compliance with ethical standards

Conflict of interest

MP, ASW, NP, SV, AM, NH, and FPKH declare that they have no conflict of interest.

Research involving human participants

This retrospective study was approved by the Institutional Review Board for biomedical research at the University of California, Irvine.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. This study was granted a waiver of informed consent as the study was deemed to pose minimal risk to the wellbeing and privacy of the patients included in the study. No patient identifiers were collected or disclosed for the purposes of this study.


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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  • Michelle Paff
    • 1
  • Alice S. Wang
    • 1
    Email author
  • Nicolas Phielipp
    • 2
  • Sumeet Vadera
    • 1
  • Anna Morenkova
    • 2
  • Neal Hermanowicz
    • 2
  • Frank P. K. Hsu
    • 1
  1. 1.Department of NeurosurgeryUniversity of CaliforniaOrangeUSA
  2. 2.Department of NeurologyUniversity of CaliforniaOrangeUSA

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