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  • da Vinci assisted paramedian supracerebellar transtentorial approach to the Mediobasal Temporal Region: a Cadaveric Study

    Final Number:

    Ahmet Akbas; Abuzer Gungor MD; Orhun Mete Cevik MD; Murat Sakir Eksi MD; Mustafa Guduk; Serdar Ozgen; Necmettin Pamir MD

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting - Late Breaking Science

    Introduction: The aim of this study was to assess the feasibility of the paramedian supracerebellar transtentorial approach for the mediobasal temporal access utilizing the da Vinci Surgical System.

    Methods: Four cadaveric heads were operated using the da Vinci Surgical System. The craniotomy for the transtentorial approach was performed lateral to the midline. The dural incision was made inferior to the transverse sinus. The system was utilized after the dural incision. The da Vinci surgical system was then used to perform arachnoid dissection and gain access to the mediobasal temporal region as well as the fusiform gyrus.

    Results: The main result observed in the study was the improved illumination and 3d perception compared to the visualization of both the surgical microscope and the endoscope. The da Vinci console offered considerable ergonomic advantages over the existing operating room arrangement, allowing the operating surgeon to remain nonsterile and seated comfortably throughout the procedure. The main limitation observed was the lack of haptic feedback.

    Conclusions: In conclusion, the system provides above par comfort for the surgeon due to the patient position. The other, perhaps the favorable advantage of the system compared to the microscopic approach is the enhanced visualization of the deep working environment.

    Patient Care: Improvement on both the da Vinci system and investigation of the possible implementation on the neurosurgical approaches opens up new opportunities.

    Learning Objectives: The study investigates the introduction of the robotic systems into neurosurgery. Both the approaches suitable for the system and the system's limitations and possible improvements are investigated. The participants will be able to 1) Learn how the system can be implemented in the transtentorial approach to the mediobasal temporal region 2) Able to investigate possible varieties of the approach 3) Learn more about the system's limitations.

    References: 1. Lee, John YK, et al. "Transoral robotic surgery of craniocervical junction and atlantoaxial spine: a cadaveric study." Journal of Neurosurgery: Spine 12.1 (2010): 13-18. 2. Marcus, Hani J., et al. "da Vinci robot-assisted keyhole neurosurgery: a cadaver study on feasibility and safety." Neurosurgical review 38.2 (2015): 367-371.

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