ABSTRACTBackgroundIn frame‐based stereotaxy, the design of the frame limits trajectory selection, e.g., to the temporal lobe and posterior fossa. We hypothesise that frame‐less neuronavigation and robotic technology might have expanded these stereotactic corridors.MethodsWe analysed 376 frame‐based, neuronavigated and robotic brain biopsies. We analysed entry (EP) and target (TP) point coordinates, trajectory lengths (TL) and angles (α1,α2), skin‐to‐skin time (STS), diagnostic yield and morbidity.ResultsRobotics liberated TP and EP selection, enabling trajectories not applicable with the frame. There was an increased application of lateral trajectories (reducing α1) while decreasing TL. There was a significant STS reduction attributable to a modification of the surgical approach (twist drill vs. burr hole).ConclusionsRobotics modified trajectory selection and the surgical approach. Duration and invasiveness of brain biopsies were decreased without affecting diagnostic yield or morbidity. This may represent a clinical benefit of robotics compared with frame‐based and frame‐less stereotaxy.
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