Microvascular decompression in trigeminal neuralgia using a robot-assisted exoscope and head-mounted display.

Abstract

Objective: Microvascular decompression (MVD) in trigeminal neuralgia (TN) is currently managed using an operating microscope (OM). Recent experiences with endoscopy-assisted, fully endoscopic, and exoscopic surgery have been described, aiming to improve ergonomics and image quality. The aim of this study was to report the first series of patients operated on with the aid of a robotic binocular exoscope using a head-mounted display (RoboticScope).

Methods: From September 2023 to March 2024, 9 patients with TN were treated using the RoboticScope. A classic mini-retrosigmoid approach was performed and standard microsurgical techniques were applied. Surgical timing, ergonomics, visual performances, adverse events, and 1-month postoperative pain outcomes were evaluated.

Results: All surgeries were completed without shifting to the OM. Surgeon comfort with the RoboticScope was better compared with the OM and visualization was good. No intraoperative adverse events were recorded. The duration of the procedure was significantly shorter with the RoboticScope compared to those using the OM (median 18 vs 34 minutes, p = 0.0001).

Conclusions: MVD can be safely and effectively performed using the RoboticScope. Surgeons benefit from better ergonomics, stereoscopic image quality, and shorter surgical duration.