{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T07:11:38Z","timestamp":1778829098034,"version":"3.51.4"},"reference-count":8,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Histomolecular tissue diagnosis is critical for treatment selection in deep-seated or multifocal intracranial lesions. Robot-assisted stereotaxy can improve workflow reproducibility and diagnostic accuracy by combining preplanned trajectories with rigid, coaxial alignment.<\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n A 46-year-old woman presented with 15 days of left leg weakness and left arm paresthesia. Contrast-enhanced magnetic resonance imaging (MRI) revealed multiple enhancing lesions, with a dominant parasagittal frontoparietal cortico-subcortical mass (~3.5 cm). A frameless robot-assisted stereotactic biopsy was performed using preoperative computed tomography (CT) and MRI fusion to define entry\/target points and avoid vascular\/eloquent structures. Intraoperatively, true orthogonal anteroposterior and lateral fluoroscopic images were acquired and registered to the preoperative CT-MRI dataset (ExcelsiusGPS \u201cMerge Images\u201d) to enable CT-to-fluoroscopy guidance. The robotic arm aligned and locked the working channel coaxially with the planned trajectory. Subsequently, a punctiform skin opening and a 2.7-mm micro-burr hole were created, the biopsy needle was advanced with controlled movements, and multiple core specimens were obtained. Postoperatively, the patient remained neurologically stable. CT showed expected tract changes without clinically significant hemorrhage. Histopathology and molecular profiling were consistent with glioblastoma, isocitrate dehydrogenase-wildtype, central nervous system World Health Organization grade 4.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n This technical video demonstrates a step-by-step frameless robot-assisted brain biopsy workflow using CT-MRI planning and CT-to-fluoroscopy registration, highlighting practical pearls for reproducible minimally invasive trajectory execution. As a single-case technical report, it illustrates workflow implementation without supporting comparative conclusions regarding safety, accuracy, efficiency, or superiority over other stereotactic methods.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_158_2026","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T06:48:41Z","timestamp":1778827721000},"page":"284","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Robot-assisted frameless brain biopsy with computed tomography-to-fluoroscopy registration: Step-by-step surgical video"],"prefix":"10.25259","volume":"17","author":[{"given":"Mario","family":"Taravilla-Loma","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"P\u00e9rez-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V\u00edctor","family":"Rodr\u00edguez-Dom\u00ednguez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catalina","family":"Vivancos S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diego Arturo","family":"Gordon Mejuto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto Isla","family":"Guerrero","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"10.25259\/SNI_158_2026\/ref-1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s10143-022-01918-w","article-title":"Advances, technological innovations, and future prospects in stereotactic brain biopsies","volume":"46","author":"Bex","year":"2023","journal-title":"Neurosurg Rev"},{"key":"10.25259\/SNI_158_2026\/ref-2","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.3171\/2024.9.FOCUS24532","article-title":"Neuro-oncology application of next-generation, optically tracked robotic stereotaxis with intraoperative computed tomography: A pilot experience","volume":"57","author":"Chuck","year":"2024","journal-title":"Neurosurg Focus"},{"key":"10.25259\/SNI_158_2026\/ref-3","doi-asserted-by":"crossref","first-page":"1173776","DOI":"10.3389\/fneur.2023.1173776","article-title":"Novel application of robot-guided stereotactic technique on biopsy diagnosis of intracranial lesions","volume":"14","author":"Feng","year":"2023","journal-title":"Front Neurol"},{"key":"10.25259\/SNI_158_2026\/ref-4","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1227\/ons.0000000000001408","article-title":"Comparative analysis of efficacy and safety of frame-based, frameless, and robot-assisted stereotactic brain biopsies: A systematic review and meta-analysis","volume":"28","author":"Gecici","year":"2025","journal-title":"Oper Neurosurg"},{"key":"10.25259\/SNI_158_2026\/ref-5","doi-asserted-by":"crossref","first-page":"928070","DOI":"10.3389\/fneur.2022.928070","article-title":"A comparation between frame-based and robot-assisted in stereotactic biopsy","volume":"13","author":"Hu","year":"2022","journal-title":"Front Neurol"},{"key":"10.25259\/SNI_158_2026\/ref-6","doi-asserted-by":"crossref","first-page":"362","DOI":"10.3390\/brainsci13020362","article-title":"A comparison of the safety, efficacy, and accuracy of frame-based versus Remebot robot-assisted stereotactic systems for biopsy of brainstem tumors","volume":"13","author":"Li","year":"2023","journal-title":"Brain Sci"},{"key":"10.25259\/SNI_158_2026\/ref-7","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/s10143-025-03463-8","article-title":"Analysis of factors influencing diagnostic yield and target point error in robot-assisted stereotactic brain biopsy: A single-center experience","volume":"48","author":"Li","year":"2025","journal-title":"Neurosurg Rev"},{"key":"10.25259\/SNI_158_2026\/ref-8","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1007\/s10143-024-03122-4","article-title":"Robot-assisted stereotactic brain biopsy: A systematic review and meta-analysis","volume":"47","author":"Porto Junior","year":"2024","journal-title":"Neurosurg Rev"}],"container-title":["Surgical Neurology 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