Introduction: Endoscopic Third Ventriculostomy (ETV) is an established and effective treatment for obstructive hydrocephalus. In its most common application, surgeons plan their entry point and endoscope trajectory for the procedure based on anatomic landmarks, then free-handedly control the endoscope. We have introduced the Rosa robot-assistance to our ETV procedure to stereotactically optimize endoscope trajectories, to reduce risk of traction on neural structures by the endoscope, and to provide a stable mechanical holder of the endoscope. Here, we present our series of Rosa robot-assisted ETVs.
Methods: At our institution, we performed Rosa robot-assisted ETVs on six consecutive subjects within a 3 month period. Patients had to have a favorable expected response to ETV (ETVSS =70) without additional endoscopic procedures (ex. Choroid plexus cauterization, septum pellucidum fenestration). The modality of image-registration (CT, MRI, surface mapping or bone fiducials) was dependent on the case.
Results: Six total pediatric subjects with an age range of 2 to 14 years, 2 females and 4 males, ETV success score ranging from 70 to 90, underwent successful ETV surgery with Rosa robotic assist within a three month period. Their intracranial pathologies included tectal gliomas (n=3), aqueductal stenosis (n=1), post-hemorrhagic hydrocephalus(n=1), and communicating hydrocephalus (n=1). Robot assistance was limited to the ventricular access in the first two procedures but was used for the entirety of the procedure for the following four cases. Four of these cases were combined with another procedural objective (2 stereotactic tectal mass biopsies, 1 Chiari decompression, and 1 ventriculoperitoneal shunt removal with EVD placement). A learning curve was observed with each subsequent surgery as registration and surgical times were shorter and more efficient. All subjects had complete resolution of their pre-procedural symptoms. There were no complications.
Conclusions: Assistance with the Rosa robot provides a safe, stable, precise, and minimally invasive approach to ETVs.
Patient Care: This series of Rosa-assisted ETV allows for a safer, more precise approach to ETVs. This minimizes neural injury from imprecise movements of the endoscope, and allows for stereotactic and minimally invasive surgical intervention to a common pediatric problem.
Learning Objectives: By conclusion of this session, participants should be able to 1) Discover if the Rosa-assisted ETV can be applied to their practice. 2) Identify the benefits of Rosa-assisted ETVs.