Robotic Skull Base Surgery via Supraorbital Keyhole Approach: A Cadaveric Study

作者：Hong Wei Chen; Tsai Jui Chang; Chang Steven D; Sorger Jonathan M^*

来源：Neurosurgery, 2013, 72: A33-A38.

DOI：10.1227/NEU.0b013e318270d9de

• da Vinci
• Feasibility studies
• Minimal invasive surgery
• Robotic surgery
• Skull base surgery
• Supraorbital keyhole surgery

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 degrees and 30 degrees 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 trans-eyebrow 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.

• 出版日期2013-1