Neurosurgical focus最新文献

{"title":"Feasibility of robotic posterior fossa skull base surgery.","authors":"Min Ho Lee, Limin Xiao, Jonathan Rychen, Mariano P Rinaldi, Muhammad Reza Arifianto, Vera Vigo, Juan C Fernandez-Miranda","doi":"10.3171/2024.9.FOCUS24341","DOIUrl":"10.3171/2024.9.FOCUS24341","url":null,"abstract":"<p><strong>Objective: </strong>Despite its potential advantages, robotic surgery has yet to be applied to skull base procedures. Complex anatomy and restricted access have limited the development of robotic skull base surgery. The authors' aim was to conduct a feasibility study of robotic surgery for posterior fossa skull base lesions.</p><p><strong>Methods: </strong>Six silicone-injected postmortem human heads were prepared for the robotic surgery. Because there was no drilling tool with the robot, specimens were dissected in advance using an endoscope and microscope. The following approaches were investigated: 1) supracerebellar-infratentorial; 2) retromastoid; and 3) posterior occipitocervical junction surgeries. For each approach specific anatomical landmarks were identified, and the surgical freedom (vertical distance angle between the tools) was measured.</p><p><strong>Results: </strong>In the case of the supracerebellar-infratentorial approach, the authors used 3 burrs with 1.5 cm of diameter: 1 paramedian and 2 laterally. The view of the pineal region was visualized, and sufficient surgical freedom of both tools was secured. The median vertical distance was 1.2 cm (range 1.1-1.8 cm), and the median angle between the tools was 105° (range 92°-110°). On the other hand, in the retromastoid approach, with a single burr 2.5 cm in diameter, the root exit zone of the facial nerve was barely visible, and a space for tools to access was not secured. The median vertical distance was 0.8 cm (range 0.6-1.0 cm), and the median angle between the tools was 10° (range 6°-12°). In the case of the posterior occipitocervical junction approach, the authors used the 3 tubular retractors, 1 in the middle and 2 laterally. Even though the space was narrow, the medulla and adjacent nerves could be identified, and a moderate level of surgical freedom could be obtained for tool mobilization. The median vertical distance was 1.6 cm (range 1.2-2.5 cm), and the median angle between the tools was 90° (range 88°-95°).</p><p><strong>Conclusions: </strong>Although robotic surgery has yet to be applied to neurosurgery, it is expected to be helpful in posterior fossa skull base surgery if appropriate tools can be developed.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E5"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design and use of assistant robotic arm in endoscopic transnasal surgery.","authors":"Anıl Ergen, Burak Çabuk, Pınar Yıldırım, Mehmet Deniz Yener, Selçuk Kizir, Melih Çaklılı, İhsan Anık, Savaş Ceylan","doi":"10.3171/2024.9.FOCUS24426","DOIUrl":"10.3171/2024.9.FOCUS24426","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop a robotic system with autonomous functionality for holding and manipulating the endoscope in endoscopic endonasal surgery. A cost-effective prototype was created with the goal of using robotic assistance and achieving a more efficient learning curve for endoscopic surgery.</p><p><strong>Methods: </strong>A Stewart platform-based endoscope holder and positioner robotic system, developed by the Mechatronics Engineering Department of Kocaeli University, was used in conjunction with 3D Slicer and Plus Toolkit open-source health technology software. Following initial configuration on a 3D skull model, the system was applied to a fresh-frozen cadaver.</p><p><strong>Results: </strong>The robotic system and its registration process proved feasible, allowing the robot to autonomously reach predetermined anatomical points during the nasal step of the surgery. Compared with a previous study by the same authors, the surgery duration was successfully shortened. The experiment yielded positive outcomes in both the artificial skull model and the cadaver. The robotic system effectively performed the nasal stage of the surgery. The integration of a robotic surgical arm in the endoscopic endonasal approach holds the potential to enhance the learning curve through shared experiences. The robot offers assistance to surgeons during the learning phase of the endoscopic endonasal approach, aiding in the identification of anatomical landmarks through preoperative planning.</p><p><strong>Conclusions: </strong>This system may present advantages such as improved visualization, enhanced maneuverability, and reduced user fatigue compared with conventional methods. These findings show the potential of robotic assistance in endoscopic surgical techniques.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E6"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limitations of current robot-assisted pedicle screw insertion systems.","authors":"Caitlyn Wandvik, Madeline E Greil, Samantha Colby, Diwas Gautam, Marcus D Mazur","doi":"10.3171/2024.9.FOCUS24545","DOIUrl":"10.3171/2024.9.FOCUS24545","url":null,"abstract":"<p><strong>Objective: </strong>As robot systems for spine surgery have been developed, they have demonstrated a high degree of accuracy in screw placement without sacrificing safety or surgical efficiency. These robotic systems offer preoperative planning and real-time feedback to enhance surgical precision and mitigate human error. Nevertheless, limitations to their optimal performance remain. The authors analyzed the initial 100 cases of pedicle screw placements performed using the Mazor X robot at their institution, presenting case examples to illustrate the limitations that were experienced, and reviewed current literature on the limitations of robot-assisted spine surgery, emphasizing their impact on accuracy and safety.</p><p><strong>Methods: </strong>This was a retrospective review of the first 100 cases of robot-assisted pedicle screw placement at the authors' institution between December 2019 and June 2024. All intraoperative CT scans were reviewed for screw accuracy. Malpositioned screws, near misses (screw deviation without injury to the patient), or abandoned robot-assisted attempts were identified, and the underlying reasons were evaluated to determine the limitations of current robot technology.</p><p><strong>Results: </strong>Of the first 100 cases of robot-assisted pedicle screw placement, there were 20 screw-related complications, of which 14 were near misses, 1 involved neurological injury caused by screw malposition, and 5 were cases in which a robot-assisted attempt was abandoned before manual screw placement. The authors identified the following limitations with current robot technology: registration errors, spine movement after registration, patient body habitus, artifact from metallic implants, poor bone differentiation, skiving, soft-tissue interference, and physical constraints.</p><p><strong>Conclusions: </strong>Despite the advancements of spine robot systems, several limitations persist, especially in mobile or unstable spine locations and around critical structures. The authors' experience, with provided case examples, further illustrates technical nuances important to understanding and navigating around these limitations. The need for standardized reporting metrics to evaluate and classify emerging technologies is highlighted, emphasizing ongoing technological innovation to enhance the efficacy of robot-assisted spine surgery.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E14"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microvascular decompression in trigeminal neuralgia using a robot-assisted exoscope and head-mounted display.","authors":"Zefferino Rossini, Maria Pia Tropeano, Andrea Franzini, Ettore Bresciani, Pietro Emiliano Doneddu, Umberto Pensato, Federico Pessina","doi":"10.3171/2024.9.FOCUS24373","DOIUrl":"10.3171/2024.9.FOCUS24373","url":null,"abstract":"<p><strong>Objective: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>MVD can be safely and effectively performed using the RoboticScope. Surgeons benefit from better ergonomics, stereoscopic image quality, and shorter surgical duration.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E9"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The safety, accuracy, and feasibility of robotic assistance in neuro-oncological surgery.","authors":"Muhammet Enes Gurses, Adham M Khalafallah, Neslihan Nisa Gecici, Elif Gökalp, Khushi Hemendra Shah, Chase Alan DeLong, Nikola Susic, Baylee Brochu, Victor M Lu, Ashish H Shah, Michael E Ivan, Ricardo J Komotar","doi":"10.3171/2024.9.FOCUS24290","DOIUrl":"10.3171/2024.9.FOCUS24290","url":null,"abstract":"<p><strong>Objective: </strong>Over the past 3 decades, robotic technology has advanced significantly across surgical fields, driven by improvements in versatility, stability, skill, and tactile properties. Neurosurgery has led the way in integrating robotics to improve the accuracy and safety of procedures that require high precision. This study aimed to present one of the largest series in the literature and investigate the feasibility and effectiveness of robotic assistance in neuro-oncological surgery.</p><p><strong>Methods: </strong>The authors performed a retrospective review of the medical records of patients who underwent stereotactic biopsy only and biopsy and laser interstitial thermal therapy (LITT) using the Robotic Surgical Assistant (ROSA) system. The ROSA system was used for trajectory planning as well as the precise alignment and insertion of the needle and/or laser catheter. All procedures were performed by a single neurosurgeon. Electronic medical records were reviewed for patient demographics, preoperative clinical deficits, diagnosis, preoperative and postoperative MR images, lesion characteristics including location and volume, postoperative complications, and deficits.</p><p><strong>Results: </strong>A total of 348 patients were identified. The mean age at surgery was 61.4 years, with 171 (49.1%) females. The most common presentations were GBM (40.5%, n = 141), metastasis (16.4%, n = 57), and radiation necrosis (9.8%, n = 34). A total of 189 (54%) patients underwent stereotactic biopsy only, and 159 (46%) underwent biopsy and LITT. The diagnostic yield of the cases was 98.6%, with only 5 cases having inconclusive pathology. Two (0.6%) patients experienced postoperative complications that resolved during follow-up. Ten (2.9%) patients developed asymptomatic subcentimeter hematomas following the procedure that did not require further intervention. No long-term consequences or permanent deficits occurred in any case within a median follow-up duration of 4.4 months (IQR 1-11.2 months).</p><p><strong>Conclusions: </strong>These results indicate that a robot-assisted approach for stereotactic biopsies and LITT is associated with a comparable diagnostic yield and safety profile for frameless and frame-based techniques. Its precision, user-friendly interface, and adaptability contribute to its suitability for such procedures. Future research, especially in long-term results and cost-effectiveness, will be crucial in fully understanding the utility and potential of this technology for broader applications in the field.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E3"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction. Robotics in the neurosurgical operating room.","authors":"Peter Vajkoczy, Katharine Drummond, Roger Hartl, Vasileios Kokkinos, Francisco A Ponce, Nicolas Sampron","doi":"10.3171/2024.9.FOCUS24598","DOIUrl":"10.3171/2024.9.FOCUS24598","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E1"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of a lightweight and table-mounted robotic alignment tool with automated patient-to-image registration using robotic cone-beam CT for intracranial biopsies and stereotactic electroencephalography.","authors":"Peter Truckenmueller, Anton Früh, Johannes Felix Kissner, Nadja Katharina Moser, Martin Misch, Katharina Faust, Julia Onken, Peter Vajkoczy, Ran Xu","doi":"10.3171/2024.9.FOCUS24525","DOIUrl":"10.3171/2024.9.FOCUS24525","url":null,"abstract":"<p><strong>Objective: </strong>Robotics in neurosurgery is becoming increasingly prevalent. The integration of intraoperative imaging for patient registration into workflows of newer robotic systems enhances precision and has further driven their widespread adoption. In this study, the authors report on a lightweight, table-mounted robotic system integrating robotic cone-beam CT (CB-CT) for automated patient registration in cranial biopsies and stereotactic electroencephalography (sEEG).</p><p><strong>Methods: </strong>This prospective cohort study included patients who underwent stereotactic biopsy or sEEG with the Cirq system from January 2023 to August 2024. For patient-to-image registration, an external registration matrix was secured near the patient's head before conducting CB-CT with robotic Artis Pheno. CT was then fused with preoperative planning MRI and used as the navigation dataset. Demographic and clinical data were evaluated, and entry and target errors, as well as vector deviation of sEEG electrodes, were assessed and compared with those of patients who underwent biopsies and sEEG with the frameless VarioGuide system.</p><p><strong>Results: </strong>In 26 Cirq-assisted surgical procedures, robotic CB-CT was used for image registration in 20 cases. Of these, 15 were biopsies (mean ± SD 7 ± 1 specimens) and 5 were sEEG with 31 depth electrodes, compared to 29 VarioGuide biopsies and 3 VarioGuide sEEG cases with 25 electrodes. The mean age was 56 ± 19 years, with a male/female ratio of 1.9:1. Lesion size averaged 19 ± 17 cm3 on T1-weighted imaging and 61 ± 53 cm3 on T2-weighted imaging for Cirq and 14 ± 14 cm3 and 68 ± 47 cm3 for VarioGuide. The mean surgical times were 117 ± 34 minutes for biopsy and 269 ± 54 minutes for sEEG in the Cirq group, with skin-to-skin times of 40 ± 23 minutes for biopsy and 208 ± 74 minutes for sEEG; in comparison, surgical times of 78 ± 21 minutes for biopsy and 218 ± 33 minutes for sEEG were reported with VarioGuide, with skin-to-skin times of 34 ± 13 and 158 ± 27 minutes. No complications occurred. The mean dosage area product was 983 ± 351 µGym2 for biopsies and 1772 ± 968 µGym2 for sEEG. Cirq-assisted sEEG electrodes had mean entry and target errors of 1.4 ± 1.2 mm and 2.6 ± 1.6 mm, compared to 5.3 ± 3.3 mm and 6.5 ± 2.8 mm with VarioGuide. Mean vector deviation was 1.6 ± 0.9 mm with Cirq versus 4.9 ± 2.9 mm with VarioGuide.</p><p><strong>Conclusions: </strong>The integration of a lightweight, table-mounted robotic alignment tool with intraoperative CB-CT for automated patient-to-image registration enables high precision and a seamless workflow. This combination is safe, has a manageable learning curve, and holds potential to replace traditional frame-based and frameless procedures. Its efficiency and accuracy are likely to contribute to the increasing adoption of robotics in neurosurgery.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E2"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Irradiation safety, anesthesia time, surgical complications, and patient-reported outcomes in the robotic Mazor X versus fluoroscopy guided minimally invasive transforaminal lumbar interbody fusion surgery: a comparative cohort study.","authors":"Daniel W Griepp, Joshua Caskey, Armando Bunjaj, Jeffrey Turnbull, Ammar Alsalahi, Hepzibha Alexander, James Dragonette, Bryce Sarcar, Shivum Desai, Doris Tong, Teck M Soo, Peter Bono, Prashant Kelkar, Clifford Houseman, Chad F Claus, Boyd F Richards, Daniel A Carr","doi":"10.3171/2024.9.FOCUS24489","DOIUrl":"10.3171/2024.9.FOCUS24489","url":null,"abstract":"<p><strong>Objective: </strong>Robot-assisted (RA) technology is becoming more widely integrated and accepted in spine surgery. The authors sought to evaluate operative and patient-reported outcomes (PROs) in RA versus fluoroscopy-assisted (FA) pedicle screw placement during minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF).</p><p><strong>Methods: </strong>The authors retrospectively studied elective patients who underwent single- or multilevel MIS TLIF for degenerative indication using FA versus RA pedicle screw placement. Patients were selected from September 2021 to May 2023 at a single institution with multiple surgeons whose practice consists of primarily MIS. Outcomes included fluoroscopy dosage per screw, operative time per screw, anesthesia time per screw, estimated blood loss (EBL), screw revision rate, inpatient surgical complications, and minimal clinically important difference (MCID) of Oswestry Disability Index (ODI) and numeric rating scale (NRS) scores at the 6- and 12-month follow-ups. Comparability of groups was analyzed by univariate analysis. Multivariable analysis modeling fluoroscopy time per screw was performed, adjusting for confounders.</p><p><strong>Results: </strong>One hundred eighty-three patients (n = 133 in the FA group vs 50 in the RA group) were included. Patients in the RA cohort were significantly younger than those in the FA group (mean age 63.8 ± 11.9 vs 59.8 ± 11.0 years, p = 0.037). A total of 932 pedicle screws were placed (mean 5.1, range 4-8 per patient). The RA cohort demonstrated significantly lower intraoperative fluoroscopy dosage per screw (4.9 ± 7.6 mGy per screw vs 20.3 ± 14.0 mGy per screw, p < 0.001), significantly longer anesthesia time per screw (49.1 ± 12.6 vs 43.6 ± 9.2, p = 0.009), and similar operative time per screw (33.3 vs 30.7 minutes, p = 0.125). The screw revision rate for symptomatic radiculopathy was zero in both groups. Revision surgery requiring screw removal or reposition was performed in 4 total cases (RA group: 1/50 for infection; FA group: 2/133 for infection, 1/133 for foraminotomy). Both groups demonstrated significant improvement in PROs at 6 and 12 months compared with preoperatively. Moreover, both groups achieved MCID at similar rates.</p><p><strong>Conclusions: </strong>When implementing RA technology, one can expect similar perioperative outcomes as FA techniques in addition to significantly lower radiation exposure. Moreover, there is no statistically significant difference in postoperative PROs between RA and FA. Longer anesthesia times may also be encountered, as in this study, which is likely a result of more complex robotic setup and workflow.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E11"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted stylomastoid foramen puncture and radiofrequency ablation for hemifacial spasm treatment: clinical outcomes and technique assessment.","authors":"Qiangqiang Liu, Wenze Chen, Changquan Wang, Bin Chen, Wenzhen Chen, Yong Lu, Chencheng Zhang, Jiwen Xu","doi":"10.3171/2024.9.FOCUS24405","DOIUrl":"10.3171/2024.9.FOCUS24405","url":null,"abstract":"<p><strong>Objective: </strong>Stylomastoid foramen (SMF) puncture with radiofrequency ablation (RFA) is a minimally invasive therapy for hemifacial spasm (HFS) with notable therapeutic outcomes. Conventionally, this procedure is performed under CT guidance. The present study highlights the authors' preliminary clinical experience with robot-assisted SMF puncture in 7 patients with HFS using a neurosurgical robot.</p><p><strong>Methods: </strong>Patients were secured in a skull clamp, and their heads were linked to the Sinovation neurosurgical robot's linkage arms for precise positioning. Bone fiducial registration was conducted using the robotic pointer. Under robotic guidance, a puncture needle was positioned at the skin entry point and then advanced to the target with a surgical blade incision. On target attainment, an RFA electrode was positioned, and the ablation was performed while monitoring facial nerve function. Preoperative and postoperative spasm grading, surgical metrics, and adverse events were meticulously documented.</p><p><strong>Results: </strong>The puncture trajectories averaged 49.5 mm in length, and the overall operation duration was 27.3 minutes. Guided by the robotic arm, all puncture attempts were successfully achieved without any obstructions, and SMF puncture was completed in a single attempt. Following RFA, immediate spasm relief was achieved, with all patients attaining Cohen spasm grade 0. Over a mean follow-up period of 12 months (range 6-15 months), no recurrence of spasms was reported. Facial paralysis was observed in 85.7% of patients, with 6 cases classified as House-Brackmann (HB) grade II and 1 case as grade III. At the final follow-up, 1 patient remained at HB grade II, while the remaining patients improved to grade I. No other lasting or severe complications were recorded.</p><p><strong>Conclusions: </strong>SMF puncture and RFA emerge as a potent and minimally invasive treatment option for HFS. The robot-assisted approach, despite necessitating additional time for head fixation and registration, notably reduces the overall puncture time, puncture attempts, and radiation exposure, thereby enhancing the puncture success rate.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E8"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy and safety evaluation of a novel artificial intelligence-based robotic system for autonomous spinal posterior decompression.","authors":"Chengxia Wang, Shuai Jiang, Zhuofu Li, Woquan Zhong, Xiongkang Song, Hongsheng Liu, Lei Hu, Weishi Li","doi":"10.3171/2024.9.FOCUS24400","DOIUrl":"10.3171/2024.9.FOCUS24400","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to introduce a novel artificial intelligence (AI)-based robotic system for autonomous planning of spinal posterior decompression and verify its accuracy through a cadaveric model.</p><p><strong>Methods: </strong>Seventeen vertebrae from 3 cadavers were included in the study. Three thoracic vertebrae (T9-11) and 3 lumbar vertebrae (L3-5) were selected from each cadaver. After obtaining CT data, the robotic system independently planned the laminectomy path based on AI algorithms before the surgical procedure and automatically performed the decompression during the procedure. A postoperative CT scan was performed, and the deviation of each cutting plane from the preoperative plan was quantitatively analyzed to evaluate the accuracy and safety of the cuts. The duration of laminectomy was also recorded.</p><p><strong>Results: </strong>A total of 285 cuts were made on thoracic and lumbar vertebrae. The average duration for unilateral longitudinal cutting was 16.38 ± 4.76 minutes, while for transverse cutting it was 4.44 ± 1.52 minutes. In terms of accuracy assessment, 3 levels were divided based on the distance between the actual cutting plane and the preplanned plane: 77 (84%) were grade A, 15 (16%) were grade B, and none were grade C. Regarding safety assessment, 74 (80%) were designated safe (grade A), with 18 (20%) classified as uncertain (grade B).</p><p><strong>Conclusions: </strong>The results confirm the accuracy and preliminary safety of the robotic system for autonomous planning and cutting of spinal decompression.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E16"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}