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.
Citations
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Applicability of a Dexterity-Enhancing Handheld Robot for 360° Endoscopic Skull Base Approaches: An Exploratory Cadaver Study Joachim Starup-Hansen, Dan Zimelewicz Oberman, John G. Hanrahan, Emmanouil Dimitrakakis, Hani J. Marcus, Joao Paulo Almeida Operative Neurosurgery.2026; 30(4): 571. CrossRef
A New Area of Neurosurgery: First Robotic Neurosurgery Clinical Case Series Umit Eroglu, Murat Zaimoglu, Eyup Bayatlı, Murat Büyüktepe, Ozgur Orhan, Engin Erdin, Elif Gokalp, Baran Can Alpergin, Hasan Caglar Ugur, Gokmen Kahilogullari, Cem Meco, Suha Beton, Hazan Basak, Yusuf Sukru Caglar, Aaron A. Cohen-Gadol Operative Neurosurgery.2026; 30(6): 929. CrossRef
Robotic-Assisted Surgery in Skull-Base Procedures: Advances, Applications, and Emerging Innovations Morad Faoury, Parag Patel International Archives of Otorhinolaryngology.2026; 30(02): 001. CrossRef
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Not Every Size Fits All: Surgical Corridors for Clival and Cervical Chordomas—A Systematic Review of the Literature and Illustrative Cases Rosario Maugeri, Lapo Bonosi, Lara Brunasso, Roberta Costanzo, Samuele Santi, Francesco Signorelli, Domenico Gerardo Iacopino, Massimiliano Visocchi Journal of Clinical Medicine.2024; 13(17): 5052. CrossRef
Jun Muto, Hidetoshi Murata, Seiji Shigekawa, Takafumi Mitsuhara, Daisuke Umebayashi, Ryo Kanematsu, Masahiro Joko, Tatsushi Inoue, Tomoo Inoue, Toshiki Endo, Yuichi Hirose, for the Investigators of Intramedullary Spinal Cord Tumors in the Neurospinal Society of Japan
Neurospine 2023;20(3):774-782. Published online September 30, 2023
Objective The characteristics, imaging features, long-term surgical outcomes, and recurrence rates of primary spinal pilocytic astrocytomas (PAs) have not been clarified owing to their rarity and limited reports. Thus, this study aimed to analyze the clinical presentation, radiological features, pathological findings, and long-term outcomes of spinal PAs.
Methods Eighteen patients with spinal PAs who were surgically treated between 2009 and 2020 at 58 institutions were included in this retrospective multicenter study. Patient data, including demographics, radiographic features, treatment modalities, and long-term outcomes, were evaluated.
Results Among the 18 consecutive patients identified, 11 were women and 7 were men; the mean age at presentation was 31 years (3–73 years). Most PAs were located eccentrically, were solid or heterogeneous in appearance (cystic and solid), and had unclear margins. Gross total resection (GTR), subtotal resection (STR), partial resection (PR), and biopsy were performed in 28%, 33%, 33%, and 5% of cases, respectively. During a follow-up period of 65 ± 49 months, 4 patients developed a recurrence; however, the recurrence-free survival did not differ significantly between the GTR and non-GTR (STR, PR, and biopsy) groups.
Conclusion Primary spinal PAs are rare and present as eccentric and intermixed cystic and solid intramedullary cervical tumors. The imaging features of spinal PAs are nonspecific, and a definitive diagnosis requires pathological support. Surgical resection with prevention of neurological deterioration can serve as the first-line treatment; however, the resection rate does not affect recurrence-free survival. Investigation of relevant molecular biomarkers is required to elucidate the regrowth risk and prognostic factors.
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Thoracic intramedullary spinal cord astrocytoma associated with syringomyelia: a case report of gross total resection Igin Ginting, Larona Hydravianto, Lukas Widhiyanto International Journal of Surgery Case Reports.2026; 138(3): 987. CrossRef
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Cervical Pilocytic Astrocytoma Mimicking Spondylotic Myelopathy: A Case Report and Literature Review Morgane M Soler-Rico, Lina Daoud, Edward Fomekong Cureus.2024;[Epub] CrossRef
The Inside Story of the Multi–center Studies in the Neurospinal Society of Japan Keisuke Takai Spinal Surgery.2024; 38(2): 105. CrossRef
Current Trends and Future Perspective of Intramedullary Spinal Cord Tumor Treatments Toshiki Endo, Yoshiharu Takahashi, Taketo Nishizawa, Tatsuya Sasaki Japanese Journal of Neurosurgery.2024; 33(6): 408. CrossRef
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