1
|
Muto J, Tateya I, Nakatomi H, Uyama I, Hirose Y. Transoral Robotic-Assisted Neurosurgery for Skull Base and Upper Spine Lesions. Neurospine 2024; 21:106-115. [PMID: 38569637 PMCID: PMC10992650 DOI: 10.14245/ns.2448062.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The application of the da Vinci Surgical System in neurosurgery is limited due to technical difficulties requiring precise maneuvers and small instruments. This study details the advantages and disadvantages of robotics in neurosurgery and the reachable range of the transoral approach to lesions of the skull base and upper cervical spine. METHODS In a cadaver study, the da Vinci Xi robot, lacking haptic feedback, was utilized for sagittal and coronal approaches on 5 heads, facilitating dura suturing in 3, with a 30°-angled drill for bone removal. RESULTS Perfect exposure of all the nasopharyngeal sites, clivus, sellar, and choana, including the bilateral eustachian tubes, was achieved without any external incisions using this palatal split approach of transoral robotic surgery. The time required to perform a single stitch, knot, and complete single suture in robotic suturing of deep-seated were significantly less compared to manual suturing via the endonasal approach. CONCLUSION This is the first report to show the feasibility of suturing the dural defect in deep-seated lesions transorally and revealed that the limit of reach in the coronal plane via a transoral approach with incision of the soft palate is the foramen ovale. This preclinical investigation also showed that the transoral robotic approach is feasible for lesions extending from the sellar to the C2 in the sagittal plane. Refinement of robotic instruments for specific anatomic sites and future neurosurgical studies are needed to further demonstrate the feasibility and effectiveness of this system in treating benign and malignant skull base lesions.
Collapse
Affiliation(s)
- Jun Muto
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Ichiro Tateya
- Department of Otolaryngology-Head and Neck Surgery, Fujita Health University, Aichi, Japan
| | | | - Ichiro Uyama
- Department of General Surgery, Fujita Health University, Aichi, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| |
Collapse
|
2
|
Corecha Santos R, Santiago RB, Gupta B, Dabecco R, Kaye B, Obrzut M, Adada B, Velasquez N, Borghei-Razavi H. Anatomical Description and Literature Review of the Endoscopic Endonasal Transclival Transodontoid Approach Combined with Endoscopic Transoral Decompression to the Anterior Craniovertebral Junction: A New Strategy. World Neurosurg 2023; 175:e151-e158. [PMID: 36931342 DOI: 10.1016/j.wneu.2023.03.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To describe and evaluate the steps required to perform a combined endoscopic endonasal/transoral transclival transodontoid approach for anterior decompression of the craniovertebral junction. METHODS The endoscopic endonasal transclival transodontoid approach combined with endoscopic transoral decompression was performed on 4 cadaveric specimens. Evaluation of this combined technique; a review of the literature; and the nuances, advantages, and pitfalls are reported. RESULTS Adequate wide anterior decompression was achieved in all specimens. This combined approach allowed the preservation of the anterior arch of C1 without injuring the eustachian tube anatomy and avoiding internal carotid artery manipulation. CONCLUSIONS Mastery of both techniques allows for a safe and comfortable surgical corridor. The transoral and transnasal approaches should not be considered as either/or techniques, but rather as a complement to each other. However, as with all new or developing techniques, there is a steep learning curve, which requires ample training in the skull base laboratory.
Collapse
Affiliation(s)
| | | | - Bhavika Gupta
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Rocco Dabecco
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Brandon Kaye
- Department of Neuroscience, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA
| | - Michal Obrzut
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Badih Adada
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Nathalia Velasquez
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | | |
Collapse
|
3
|
Shkarubo AN, Nikolenko VN, Chernov IV, Andreev DN, Shkarubo MA, Chmutin KG, Sinelnikov MY. Anatomical Aspects of the Transnasal Endoscopic Access to the Craniovertebral Junction. World Neurosurg 2019; 133:e293-e302. [PMID: 31520764 DOI: 10.1016/j.wneu.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Interest in endoscopic transnasal access has increased with continued technological advances in endoscopic technology. The goals of this study were to review the normal anatomy in transnasal endoscopic neurosurgery and outline the anatomical basis for an expanded surgical approach. Defining anatomical aspects of surgical endoscopy helps guide the surgeon by defining normal anatomy of the access vector. METHODS This anatomic study was conducted on 15 adult male cadaver specimens using various microsurgical tools and endoscopic instruments and 1 intraoperative case. The vasculature was injected with colored silicone to aid visualization. Different transnasal approach techniques were used, with angles of endoscope access at 0°, 30°, 45°, and 70° accordingly for extensive anatomical mapping. RESULTS The proximity of critical structures is different in each approach degree. A full understanding of the possible structures to be met during transnasal access is described. As a result of the study, anatomical aspects and important structures were outlined, and a surgical protocol was defined for minimal risk access in respect to normal anatomy of the area. CONCLUSIONS Thorough knowledge of topographic anatomy of the craniovertebral junction is required for performing minimal-risk surgical intervention in this region. It is important to know all anatomical aspects of the transnasal approach in order to reduce the risk of damage to vital structures. Transnasal endoscopic surgery of the craniovertebral junction is a relatively new direction in neurosurgery; therefore, anatomical studies such as the one described in this article are extremely important for the development of this access method.
Collapse
Affiliation(s)
- Alexey Nikolaevich Shkarubo
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation; Department of Neurosurgery, RUDN University, Moscow, Russian Federation; Department of Neurosurgery, N.N. Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russian Federation.
| | - Vladimir Nikolaevich Nikolenko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation; Department of Anatomy, Lomonosov Moscow State University, Moscow, Russian Federation
| | - Ilia Valerievich Chernov
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Dmitry Nikolaevich Andreev
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Mikhail Alekseevich Shkarubo
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | | | - Mikhail Yegorovich Sinelnikov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| |
Collapse
|
4
|
Abstract
This study aimed to explore the feasibility and clinical effectiveness of a combined transoral and endoscopic approach for the removal of benign cervical spine tumors.First, we obtained detailed anatomical measurements of the atlantoaxial joint from 20 fresh cadaveric specimens and performed simulated surgeries with the combined transoral and endoscopic approach on 10 cadaveric specimens. Then, we applied the combined approach for the resection of benign cervical spine tumors in 8 patients at our hospital from October 2013 to October 2015. All patients underwent enhanced axial, coronal, and sagittal computed tomography (CT) examination before and after surgery. Preoperative 3-dimensional (3D) reconstruction and printing models were used in 5 cases.On the basis of CT measurements of fresh cadaveric atlantoaxial anatomy and practical experiences from simulated surgeries on the cadaveric specimens with latex perfusion, cervical tumors were completely removed from 8 patients without complications. The average surgery time was 73 minutes, and the average intraoperative bleeding volume was 34 mL. The average hospital stay was 6.5 days. The average NRS score of patients was 2.25 points at 3 days postoperation. At the 12-month postoperative follow-up, the atlantoaxial vertebral bone had been largely repaired, and no recurrence was observed by cervical CT examination.The combined transoral and endoscopic approach could be used safely and effectively to excise cervical spine tumors with substantial advantages, including direct surgical access, relatively simple operation, short operative time, quick postoperative recovery, a reliable curative effect, and few complications.
Collapse
Affiliation(s)
- Jun Zhou
- Department of Head and Neck Surgery & Otolaryngology, The People's Hospital of Longhua
| | - Yong-Tian Lu
- Department of Head and Neck Surgery & Otolaryngology, The Second People's Hospital of Shenzhen, Shenzhen, China
| | - Fei-Yan Lu
- Department of Head and Neck Surgery & Otolaryngology, The Second People's Hospital of Shenzhen, Shenzhen, China
| |
Collapse
|
5
|
Visocchi M, Iacopino DG, Signorelli F, Olivi A, Maugeri R. Walk the Line. The Surgical Highways to the Craniovertebral Junction in Endoscopic Approaches: A Historical Perspective. World Neurosurg 2018; 110:544-557. [PMID: 29433179 DOI: 10.1016/j.wneu.2017.06.125] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/17/2017] [Accepted: 06/19/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND We compiled a comprehensive literature review on the anatomic and clinical results of endoscopic approaches to the craniocervical junction (CVJ) to better contribute to identify the best strategy. METHODS An updated literature review was performed in the PubMed, OVID, and Google Scholar medical databases, using the terms "Craniovertebral junction," "Transoral approach," "Transnasal approach," "Transcervical approach," "Endoscopic endonasal approach," "Endoscopic transoral approach," "Endoscopic transcervical approach." Clinical series, anatomic studies, and comparative studies were reviewed. RESULTS Pure endonasal and cervical endoscopic approaches still have some disadvantages, including the learning curve and the deeper surgical field. Endoscopically assisted transoral surgery with 30° endoscopes represents an emerging option to standard microsurgical techniques for transoral approaches to the anterior CVJ. This approach should be considered as complementary rather than an alternative to the traditional microsurgical transoral-transpharyngeal approach. CONCLUSIONS The transoral approach with sparing of the soft palate still remains the gold standard compared with the pure transnasal and transcervical approaches because of the wider working channel provided by the former technique. The transnasal endoscopic approach alone appears to be superior when the CVJ lesion exceeds the upper limit of the inferior third of the clivus.
Collapse
Affiliation(s)
| | - Domenico Gerardo Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Palermo, Italy
| | | | - Alessandro Olivi
- Institute of Neurosurgery, Catholic University of Rome, Rome, Italy
| | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Palermo, Italy.
| |
Collapse
|