{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T21:23:59Z","timestamp":1788989039440,"version":"build-2803163510"},"reference-count":90,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Conventional frame-based stereotaxy through a transfrontal approach (TFA) is the gold standard in brainstem biopsies. Because of the high surgical morbidity and limited impact on therapy, brainstem biopsies are controversial. The introduction of robot-assisted stereotaxy potentially improves the risk-benefit ratio by simplifying a transcerebellar approach (TCA). The aim of this single-center cohort study was to evaluate the risk-benefit ratio of transcerebellar brainstem biopsies performed by 2 different robotic systems. In addition to standard quality indicators, a special focus was set on trajectory selection for reducing surgical morbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This study included 25 pediatric (n = 7) and adult (n = 18) patients who underwent 26 robot-assisted biopsies via a TCA. The diagnostic yield, complication rate, trajectory characteristics (i.e., length, anatomical entry, and target-point location), and skin-to-skin (STS) time were evaluated. Transcerebellar and hypothetical transfrontal trajectories were reconstructed and transferred into a common MR space for further comparison with anatomical atlases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Robot-assisted, transcerebellar biopsies demonstrated a high diagnostic yield (96.2%) while exerting no surgical mortality and no permanent morbidity in both pediatric and adult patients. Only 3.8% of cases involved a transient neurological deterioration. Transcerebellar trajectories had a length of 48.4 \u00b1 7.3 mm using a wide stereotactic corridor via crus I or II of the cerebellum and the middle cerebellar peduncle. The mean STS time was 49.5 \u00b1 23.7 minutes and differed significantly between the robotic systems (p = 0.017). The TFA was characterized by longer trajectories (107.4 \u00b1 11.8 mm, p &lt; 0.001) and affected multiple eloquent structures. Transfrontal target points were located significantly more medial (\u22123.4 \u00b1 7.2 mm, p = 0.042) and anterior (\u22123.9 \u00b1 8.4 mm, p = 0.048) in comparison with the transcerebellar trajectories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Robot-assisted, transcerebellar stereotaxy can improve the risk-benefit ratio of brainstem biopsies by avoiding the restrictions of a TFA and conventional frame-based stereotaxy. Profound registration and anatomical-functional trajectory selection were essential to reduce mortality and morbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2021.10.focus21359","type":"journal-article","created":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T10:20:58Z","timestamp":1641032458000},"page":"E12","source":"Crossref","is-referenced-by-count":17,"title":["Rediscovery of the transcerebellar approach: improving the risk-benefit ratio in robot-assisted brainstem biopsies"],"prefix":"10.3171","volume":"52","author":[{"given":"Kathrin","family":"Machetanz","sequence":"first","affiliation":[{"name":"Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen;"},{"name":"Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Grimm","sequence":"additional","affiliation":[{"name":"Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen;"},{"name":"Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Wang","sequence":"additional","affiliation":[{"name":"Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin U.","family":"Schuhmann","sequence":"additional","affiliation":[{"name":"Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos","family":"Tatagiba","sequence":"additional","affiliation":[{"name":"Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Gharabaghi","sequence":"additional","affiliation":[{"name":"Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen;"},{"name":"Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Naros","sequence":"additional","affiliation":[{"name":"Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen;"},{"name":"Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1227\/00006123-198706000-00019","article-title":"Computed imaging stereotaxy: experience and perspective related to 500 procedures applied to brain masses","volume":"20","author":"Apuzzo MLJ","year":"1987","unstructured":"Apuzzo MLJ, Chandrasoma PT, Cohen D, Zee CS, Zelman V. 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