Early Clinical Experience with the Stealth Autoguide Cranial Robotic Guidance Platform for Stereotactic Brain Biopsy

Objective The aim of this study was to report the early clinical experience with stereotactic biopsy using the Medtronic Stealth Autoguide Cranial Robotic Guidance Platform, representing the first relevant clinical study in the Republic of Korea (ROK). We evaluated potential advantages and limitations related to workflow integration, instrument setup, procedural efficiency, accuracy, and safety.

Methods A retrospective case series was conducted across three centers in the ROK. From April to July 2025, 17 consecutive patients underwent frameless stereotactic biopsy using the Stealth Autoguide system. Data on demographics, operative time, and complications were collected, and descriptive analyses were performed.

Results Biopsy using the Stealth Autoguide was successfully completed in 16 of 17 patients. The median operative time was 48 minutes (interquartile range, 33-64), and the median target alignment error was 0.4 mm (interquartile range, 0.3-0.6). One case required conversion to the conventional manual method due to targeting inaccuracy. Three cases of asymptomatic intracerebral hemorrhage occurred, including one at the tissue-harvest site and two with cortical hemorrhage, all of which were managed conservatively.

Conclusion The Stealth Autoguide system facilitates a more efficient frameless stereotactic biopsy than conventional methods by reducing operative time, enhancing accuracy, and allowing for a smaller, muscle-sparing incision. However, some concerns remain, and further clinical validation is needed to define its optimal indications and safety profile.