Robotic placement of a CNS ventricular reservoir for administration of chemotherapy

Abstract

The application of robotic technology to surgery holds great promise for improving surgical outcomes and reducing morbidity. We hypothesized that image-guided, robotic placement of a CNS ventriculostomy reservoir for intraventricular chemotherapy is safe, highly accurate, and highly reproducible. Eleven patients requiring catheter ventriculostomy for reservoir placement were included in this retrospective study. All underwent image-guided, robotic placement of a ventricular catheter, using a pre-operatively defined trajectory. All catheters entered the targeted structure. There were no catheter-related hemorrhages and no injury to adjacent neural structures. Mean distance of the catheter tip from target was 1.6 mm. Mean operative time was 42.8 minutes. Robotic placement of a reservoir ventriculostomy using a pre-planned trajectory is safe, highly accurate, and highly reliable. This makes single-pass ventriculostomy possible in nearly all patients, even those with very small ventricles, and may permit catheter-based therapies in patients who would otherwise be deemed poor surgical candidates by virtue of ventricular size. It also permits careful pre-operative study and optimization of the catheter trajectory, which may be beneficial in minimizing risk to bridging veins and sulcal vessels.

Key words:

• Robot
• robotics
• neurosurgery
• ventriculostomy
• stereotaxy