ArticleBrain & spine2026
Frameless robotic stereotactic brain biopsy workflow with CT-MRI fusion and CT-to-fluoroscopy registration: Step-by-step technical note and early experience.
Article in Brain & spine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Stereotactic brain biopsy is a widely used procedure for the histopathological and molecular diagnosis of different types of brain lesions. While frame-based techniques remain highly accurate, frameless neuronavigation and robotic platforms have progressively streamlined workflow and standardization. Practical, reproducible registration strategies are key to facilitate safe implementation across centers. Research question: We describe a frameless, robot-assisted stereotactic brain biopsy workflow based on preoperative CT-MRI fusion and intraoperative fiducial-free CT-to-fluoroscopy registration, and report technical considerations for reproducible adoption. Material and methods: A robot-assisted brain biopsy was performed on a patient with a right frontal butterfly-shaped lesion, based on CT-MRI fusion and CT-to-fluoroscopy "Merge Images" registration. We detail the step-by-step workflow, including the registration strategy, technical advantages and disadvantages, and our initial experience with this protocol. Results: CT-to-fluoroscopy registration provided reliable intraoperative anatomical correlation and was integrated into the routine setup without intraoperative CT or cone-beam CT. In the index case (and in our early experience), tissue sampling provided a conclusive histomolecular diagnosis, with procedure times consistent with routine stereotactic biopsy practice and no major procedure-related complications. Discussion and conclusion: This technical note outlines a reproducible, step-by-step workflow for robot-assisted stereotactic brain biopsy based on CT-MRI fusion and CT-to-fluoroscopy registration, supported by a standardized operating-room setup. We highlight the practical checkpoints that keep the procedure reliable in routine use, particularly strict fusion verification and uninterrupted optical tracking. Further experience and larger series are warranted to refine its role alongside established stereotactic techniques.
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