Medicinal, Psychological, and Health Research Journal (MPHRJ)

Abstract Brain metastases represent the most common intracranial tumors in adults, frequently requiring multimodal management including surgical resection and stereotactic radiosurgery (SRS). The optimal timing of SRS—either administered preoperatively or postoperatively— remains a subject of ongoing debate. This systematic review and meta-analysis aimed to compare clinical outcomes between preoperative and postoperative SRS in patients undergoing surgical resection for brain metastases. A comprehensive literature search conducted across major databases including PubMed, Scopus, and Web of Science up to 2025. Studies directly comparing preoperative and postoperative SRS in adult patients with resectable brain metastases were included. Primary outcomes were local control, leptomeningeal disease (LMD) incidence, radiation necrosis, overall survival (OS), and distant brain failure (DBF). Data were pooled using random-effects models, and heterogeneity assessed using the I² statistic. Across eligible retrospective and prospective cohort studies, preoperative SRS demonstrated significantly lower rates of LMD and symptomatic radiation necrosis compared with postoperative SRS. Local control rates were comparable between groups, while overall survival did not differ significantly. Preoperative SRS was associated with improved target delineation and reduced irradiation volume, potentially explaining the lower complication rates. In conclusion, preoperative SRS appears to provide similar oncologic control with reduced treatment-related toxicity compared to postoperative SRS. These findings support consideration of preoperative SRS as an effective alternative strategy in appropriately selected patients, although randomized controlled trials are required to confirm long-term comparative benefits.

Abstract Background: Deep Brain Stimulation (DBS) is a well-established neurosurgical intervention for movement disorders, particularly Parkinson’s disease, essential tremor, and dystonia. Accurate electrode placement is critical for optimal therapeutic outcomes and minimizing complications. Conventional DBS techniques rely on frame-based stereotactic systems and intraoperative microelectrode recording, while robot-assisted DBS has emerged as a technological advancement aimed at improving precision, reducing operative time, and enhancing patient safety. Objective: This systematic review and meta-analysis aimed to compare the clinical and surgical outcomes of robot-assisted DBS with conventional techniques across published studies, assessing efficacy, safety, accuracy, and procedural efficiency.

Methods: A comprehensive literature search conducted across PubMed, Embase, Web of Science, and Cochrane Library databases for studies published up to February 2026. Eligible studies included randomized controlled trials, cohort studies, and case series comparing robot-assisted DBS with conventional methods. Data on clinical outcomes (motor improvement, quality of life, and medication reduction), surgical outcomes (operative time, electrode placement accuracy, and complication rates), and adverse events were extracted. Meta-analytic techniques using random-effects models applied to pooled data, and heterogeneity assessed using the I² statistic.

Results: Twenty-one studies involving 1,342 patients met the inclusion criteria. Robot-assisted DBS demonstrated comparable or superior clinical efficacy compared with conventional techniques, with significantly improved electrode placement accuracy (mean difference: 0.78 mm; 95% CI: 0.42–1.14; p < 0.001). Operative times reduced in robot-assisted procedures by an average of 32 minutes per case. Complication rates, including hemorrhage and infection, were similar between groups. Subgroup analyses indicated that the benefits of robotic assistance particularly pronounced in complex or bilateral procedures. Conclusions: Robot-assisted DBS offers a reliable and precise alternative to conventional techniques, with comparable clinical outcomes, improved surgical accuracy, and reduced operative time. These findings support broader adoption of robotic systems in DBS surgery, particularly for centers aiming to enhance procedural efficiency and patient safety.