Deep brain stimulation (DBS) is a surgical treatment for movement disorders — primarily Parkinson’s disease, essential tremor, and dystonia — in which thin electrodes are implanted precisely within specific nuclei deep in the brain. Getting the electrode tip within a millimeter or two of the target nucleus determines whether stimulation works; placement errors of even a few millimeters can mean the difference between effective symptom control and a revision operation. Robotic assistance addresses the accuracy problem directly by replacing manual frame-based trajectory execution with computer-guided, mechanically constrained electrode delivery.
What DBS Surgery Involves
DBS targets are small anatomical structures located 60–90 mm below the skull surface, identified on MRI and CT imaging:
- Subthalamic nucleus (STN) — approximately 9 × 7 × 4 mm in size, the primary target for Parkinson’s disease
- Globus pallidus internus (GPi) — used for Parkinson’s disease and dystonia
- Ventral intermediate nucleus (VIM) of the thalamus — used for essential tremor
The surgical steps are:
- Pre-operative MRI/CT fusion to localize the target nucleus in three-dimensional space
- Trajectory planning to define the angle and depth of electrode insertion — avoiding sulci, sulcal vessels, and eloquent cortex
- Burr hole creation in the skull
- Electrode insertion along the planned trajectory
- Intraoperative neurophysiological testing (microelectrode recording or stimulation testing) to confirm target localization
- Connection to an implanted pulse generator (IPG) in the chest or clavicular region
Traditionally, this was performed using a stereotactic frame — a mechanical halo fixed to the skull that establishes a coordinate system used to guide electrode insertion. Frame-based stereotaxy has been used for decades and remains accurate, but frames are uncomfortable for patients, require a separate attachment procedure, and impose workflow constraints.
Why Accuracy Is the Central Challenge
The subthalamic nucleus is roughly the size of a small olive. The electrode tip must land within this structure to achieve therapeutic stimulation — ideally within 1–2 mm of the intended target. Placement accuracy matters for two independent reasons:
Efficacy. The STN and GPi are surrounded by structures with different functions. An electrode placed a few millimeters off-target may stimulate adjacent nuclei, producing side effects (dysarthria, cognitive effects, muscle contractions) rather than the intended therapeutic response.
Revision rate. Off-target implants may require revision surgery, which carries its own risks in a brain that has already been operated on.
A review published in Brain Sciences (Mirzadeh Z, et al., 2021) notes that robotic systems have demonstrated targeting errors in the 0.5–1.5 mm range in reported series, competitive with experienced frame-based stereotaxy.
How Robotic Systems Improve DBS
Robotic DBS assistance operates at the trajectory execution step. The surgical plan — target coordinates, entry point, trajectory angle — is computed pre-operatively. The robot physically positions a guiding arm at the planned angle and depth, which the surgeon uses to insert the electrode mechanically constrained along the planned path.
This addresses several limitations of manual execution:
Tremor elimination. The surgeon’s hand tremor is mechanically decoupled from the electrode trajectory. Electrode deviation due to physiological hand movement is eliminated.
Reproducible positioning. The robot executes the same positioning algorithm for every case, reducing case-to-case variability attributable to operator technique.
No frame requirement. Many robotic systems operate in frameless mode, using intraoperative image registration instead of a skull-mounted frame. This improves patient comfort and streamlines workflow.
Multiple trajectory planning. In bilateral DBS (both hemispheres implanted in the same session), the robot can switch between left and right hemisphere trajectories with registered repositioning.
The Remebot Neurosurgical Robot by Remebot received NMPA approval in 2018 and has been used in Chinese clinical practice for DBS targeting as well as biopsy and hematoma evacuation procedures. The Sinovation X1000 by Sinovation is another Chinese platform used for stereotactic neurosurgical applications including DBS.
For a broader view of surgical navigation technology, see Optical vs Electromagnetic Surgical Navigation.
Intraoperative Confirmation
Robotic positioning does not eliminate the need for intraoperative confirmation. Most DBS centers use microelectrode recording (MER) — a thin mapping electrode that records characteristic firing patterns of specific nuclei — to physiologically verify that the planned target has been reached before the therapeutic electrode is implanted. MER adds time to the procedure but provides a biological confirmation layer that imaging-based planning alone cannot provide.
Some centers perform DBS under general anesthesia (asleep DBS), relying entirely on imaging and robotic accuracy without awake patient testing. This requires higher confidence in planning accuracy and is more practical when robotic assistance is used.
The Chinese DBS Context
DBS for Parkinson’s disease has been performed in Chinese tertiary hospitals since the late 1990s, initially using imported systems. The development of domestic neurosurgical robotic platforms — along with China’s large Parkinson’s patient population — has increased interest in domestic robotic DBS programs. According to the WHO, Parkinson’s disease affects an estimated 8.5 million people globally, with China accounting for a substantial share of that burden given its population size.
For understanding how Chinese robotic neurosurgical devices obtain market authorization, see How NMPA Class III Medical Device Approval Works in China.
Frequently Asked Questions
Is DBS a permanent implant?
The electrodes are intended to remain in place indefinitely. The implanted pulse generator has a battery that requires replacement every several years (or is rechargeable in some modern devices). The electrodes themselves are rarely removed unless there is infection, hardware failure, or a decision to discontinue therapy.
Can DBS surgery be done on both sides of the brain in the same session?
Yes. Bilateral DBS — simultaneous left and right hemisphere electrode placement — is common for Parkinson’s disease, where symptoms are often bilateral. Robotic systems facilitate bilateral procedures by enabling registered repositioning between the two trajectories without re-fixating a frame.
What is the role of imaging in robotic DBS?
Pre-operative MRI defines target anatomy and the electrode trajectory. CT is often fused to MRI for better bone landmark definition. Intraoperatively, the robot uses either the pre-operative image set (with skull-surface registration) or intraoperative CT/MRI to confirm its coordinate system before executing the trajectory.
Does robotics eliminate the need for microelectrode recording?
Not at most centers. MER provides neurophysiological confirmation of target anatomy that imaging cannot fully replicate. Some centers perform asleep DBS without MER, relying on imaging and robot accuracy, but this practice varies by institution and preference.
Are there risks specific to robotic DBS compared to frame-based DBS?
The risks of electrode insertion — hemorrhage, infection, misplacement — are similar for both approaches. Robotic systems introduce the possibility of registration errors (if the robot’s coordinate system is not properly aligned with the patient’s anatomy), which is why intraoperative verification steps remain important regardless of robotic assistance.