Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Journal of robotic surgery
Robot-Assisted versus non-robotic frame-based deep brain stimulation: a systematic review and meta-analysis of targeting accuracy and clinical outcomes
Deep brain stimulation (DBS) outcomes depend on accurate lead placement. Robot-assisted DBS (RA-DBS) has been increasingly adopted, yet its advantages over conventional non-robotic frame-based DBS (NRA-DBS) regarding targeting accuracy, operative efficiency, and clinical outcomes remain debated.To compare RA-DBS versus NRA-DBS for targeting accuracy and clinical outcomes in patients undergoing DBS for movement disorders.This meta-analysis and systematic review was registered in PROSPERO (CRD420261336001) and adhered to PRISMA. Patients with mobility disorders treated with RA-DBS versus frame-based NRA-DBS were included in comparative studies (RCTs and prospective/retrospective cohorts). Targeting accuracy measures (such as target point error, vector error, and radial error) and extreme targeting outliers were the main results. Operative time measurements, perioperative problems (such as cerebral bleeding), and motor improvement (UPDRS-III) were secondary outcomes. Fixed-effects or random-effects models based on heterogeneity were used to compute pooled odds ratios (OR) and weighted mean differences (MD) with 95% confidence intervals (CI). Nine high-quality comparative studies encompassing 495 patients (227 RA-DBS vs. 268 NRA-DBS) were synthesized. RA-DBS significantly minimized target point error (MD = -0.31 mm, 95% CI: -0.61 to -0.01; P = 0.04) and significantly reduced the incidence of clinically significant targeting outliers (OR = 0.15, 95% CI: 0.04 to 0.51; P = 0.002). Comprehensive three-dimensional vector error was marginally lower in the RA-DBS cohort (MD = -0.70 mm; P = 0.05), whereas two-dimensional radial error and total operating room time, surgical duration, anesthesia time, perioperative complications, and 12-month UPDRS-III motor improvements were statistically equivalent between groups. Subgroup analyses revealed that the spatial precision advantage of RA-DBS was geographically robust across East Asian and Western cohorts, whereas chronological efficiency was heavily dependent on the specific robotic platform used.Compared with conventional frame-based stereotaxy, robot-assisted DBS significantly enhances target point precision and reduces electrode deviations. However, these technical accuracy advantages do not translate into overall clinical superiority, as both approaches yield comparable operative efficiency, perioperative safety, and mid-term motor symptom relief.
23 June 2026
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Bed nucleus of the stria terminalis-nucleus accumbens stimulation for depression: A randomized, double-blind, crossover trial
Although deep brain stimulation (DBS) shows potential in treatment-resistant depression (TRD), the efficacy remains controversial. To assess the efficacy of DBS of the bed nucleus of the stria terminalis (BNST) and nucleus accumbens (NAc) for TRD, we conduct a randomized, double-blind, crossover trial after an open-label optimization stage. Stimulation leads to a mean decrease in the Hamilton Depression Scale-17 (HAMD) scores of 10.1 points (p < 0.001) with a 50% response rate at the end of the open-label stage. Anxiety, quality of life, and disability are also improved. The HAMD scores are significantly lower in patients during active DBS than during sham DBS (p < 0.001). Serious adverse events include suicide (1 patient) and seizure (1 patients). With individual stimulation analysis, we identify optimal stimulation sites, fiber tracts, and functional networks (false discovery rate [FDR] p < 0.05). This study demonstrates the efficacy and safety of BNST-NAc DBS for TRD and reveals optimal brain targets for stimulation. This study was registered at ClinicalTrials.gov (NCT04530942).
25 Apr 2026
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