Three-dimensional analysis of microneurosurgical approach for robotic surgery

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Establishment of robotic surgery is needed to perform further accurate microneurosurgery for lesions in the central nervous system. The lesions of the central nervous system is cooped in the hard skull and the anatomical structures around the lesions are very complex. Therefore, more accurate microneurosurgical technique is required than surgeries in the other locations. The robotic surgery is not yet practical because of the anatomical complexity of the central nervous system. In order to advance the robotic system for neurosurgery, we found it necessary to analyze the surgical approaches to various intracranial lesions, for example, cerebral aneurysm, arteriovenous malformation, pituitary adenoma, craniopharyngioma, meningioma, acoustic neurinoma, etc. The aim of the present study is to obtain data regarding the surgical approaches to undergo microsurgical robotic operation under high magnification.Retrospective analysis was performed to know factors for influencing functional outcom … More e and best treatment strategy in craniopharyngiomas. 56 patients were treated between 1978 and 2005. They were initially treated with surgery and surgical cure was obtained in 29 patients (Group A). Subtotal tumor resection with prophylactic radiation was performed in 8 patients (Group D). Tumor recurrence was noted in 19 patients and stereotactic radiation or 2nd operation was performed in 11 patients (Group B). 2nd operation and fractionated radiation were undertaken in 8 patients (Group C). Endocrine, vision and recognition were scored from 2 to 0, respectively ; 2 indicates normal, 1 partially disturbed, 0 fully disturbed. The mean score before treatment was 4.7 and the final was 3.9. Factors leading to poor outcome included extrasellar origin, solid tumor, bad score before treatment, 2nd surgery for recurrence. The change of scores after the treatment was-0.1 in group A, -0.7 in Group B, -0.9 in Group C and 0.3 in Group D. Maximum tumor removal should be attempted with functional preservation. Subtotal removal with prophylactic radiation is recommended if the patient had normal hypothalamic function.The aim of vestibular schwannoma surgery for neurosurgeons in the era of gamma knife is total tumor removal without any neurological deterioration. We describe anatomical landmarks such as emissary vein, subarcuate artery, endolymphatic sac, vestibular aqueduct, common crus, jugular bulb, and cochlear aqueduct and the related surgical techniques. The suboccipital approach is one of the most fundamental surgical approaches in neurosurgery and should be always revised based on the recent neuroimaging studies and anatomical knowledge Less