机械后颅窝颅底手术的可行性。

IF 3.3 2区 医学 Q2 CLINICAL NEUROLOGY
Min Ho Lee, Limin Xiao, Jonathan Rychen, Mariano P Rinaldi, Muhammad Reza Arifianto, Vera Vigo, Juan C Fernandez-Miranda
{"title":"机械后颅窝颅底手术的可行性。","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":null,"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":3.3000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"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\":null,\"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\":3.3000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurosurgical focus\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3171/2024.9.FOCUS24341\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosurgical focus","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3171/2024.9.FOCUS24341","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

摘要

目的:尽管机器人手术具有潜在的优势,但它尚未应用于颅底手术。复杂的解剖结构和受限的进入限制了机器人颅底手术的发展。作者的目的是进行机器人手术治疗后窝颅底病变的可行性研究。方法:制备6个经硅胶注射的死后人头,用于机器人手术。由于机器人没有钻孔工具,因此使用内窥镜和显微镜对标本进行了提前解剖。研究了以下入路:1)小脑上-幕下;2) retromastoid;3)后枕颈结手术。对于每个入路,确定了特定的解剖标志,并测量了手术自由度(工具之间的垂直距离角)。结果:在小脑上-幕下入路的病例中,作者使用了3个直径为1.5 cm的毛刺:1个侧边,2个侧边。松果体区域的视野是可视化的,两种工具的足够的手术自由是有保障的。中位垂直距离为1.2 cm (1.1-1.8 cm),工具之间的中位角度为105°(92°-110°)。另一方面,在乳突后入路中,只有一个直径2.5 cm的毛刺,面神经根出口区几乎不可见,工具进入的空间不安全。中位垂直距离为0.8 cm (0.6-1.0 cm),工具之间的中位角度为10°(6°-12°)。在后枕颈交界处入路的情况下,作者使用了3个管状牵开器,1个在中间,2个在外侧。虽然空间狭窄,但可以识别髓质和邻近的神经,并且可以获得中等程度的手术自由度来移动工具。中位垂直距离为1.6 cm (1.2-2.5 cm),工具之间的中位角度为90°(88°-95°)。结论:虽然机器人手术尚未应用于神经外科,但如果能开发出合适的工具,机器人手术有望在后颅窝颅底手术中有所帮助。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Feasibility of robotic posterior fossa skull base surgery.

Objective: 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.

Methods: 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.

Results: 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°).

Conclusions: 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.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Neurosurgical focus
Neurosurgical focus CLINICAL NEUROLOGY-SURGERY
CiteScore
6.30
自引率
0.00%
发文量
261
审稿时长
3 months
期刊介绍: Information not localized
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信