Robotic skull base surgery via supraorbital keyhole approach: a cadaveric study.

Abstract:

BACKGROUND:The supraorbital keyhole approach has been used in anterior skull base tumor and aneurysm surgery. However, there are debates regarding the safety and limitations of this kind of approach. OBJECTIVE:To determine the feasibility and potential benefits of surgical robotic technology in minimally invasive neurosurgery. METHODS:Two fresh cadaver heads were studied with the da Vinci Surgical System with 0° and 30° stereoscopic endoscopes to visualize neuroanatomy. The ability of the system to suture and place clips under the keyhole approach was tested. RESULTS:The da Vinci Surgical System was used throughout the supraorbital transeyebrow keyhole approach. With the use of standard microdissection techniques, the optic nerve, optic chiasm, carotid artery, and third cranial nerve were visualized. The sylvian fissure was then exposed from the proximal sylvian membrane to the distal M1 segment. With the EndoWrist microforceps, suturing can be achieved smoothly to close a defect created on the M2 artery. Although the benefits in adjusting clips during aneurysm surgery could be provided by an articulating applier, a proper robotic applier is not currently available. CONCLUSION:The minimally invasive supraorbital keyhole surgery can be achieved with the da Vinci Surgical System in cadaver models. This system provides neurosurgeons with broader vision and articulable instruments, which standard microsurgical systems do not provide. Further studies are necessary to evaluate the safety and benefits of using the da Vinci Surgical System in minimally invasive neurosurgery.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Hong WC,Tsai JC,Chang SD,Sorger JM

doi

10.1227/NEU.0b013e318270d9de

subject

Has Abstract

pub_date

2013-01-01 00:00:00

pages

33-8

eissn

0148-396X

issn

1524-4040

pii

00006123-201301001-00007

journal_volume

72 Suppl 1

pub_type

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