Robotic Arm-Protected Microsurgical Pericallosal and Middle Cerebral Artery Aneurysm Clipping: A Technical Note and Case Series

医学 剪裁(形态学) 动脉瘤 大脑中动脉 外科 显微外科 系列(地层学) 内科学 语言学 生物 哲学 古生物学 缺血
作者
E. Yeung,Keaton Piper,Jeffrey Farooq,Jianjian Zhang,Siviero Agazzi,Harry van Loveren,Tsz Lau
出处
期刊:Operative Neurosurgery [Oxford University Press]
卷期号:24 (1): 88-93 被引量:1
标识
DOI:10.1227/ons.0000000000000447
摘要

BACKGROUND: Managing intraoperative aneurysm rupture (IAR) during intracranial aneurysm clipping can be challenging given the excessive hemorrhage and limited field of view under the microscope for visualizing the proximal artery and safe temporary clipping. OBJECTIVE: To describe the first known use of robotic arm for safeguarding IAR in microsurgical aneurysm clipping. METHODS: A robotic arm was used to safeguard 3 microsurgical clipping cases (1 pericallosal and 2 middle cerebral artery) performed by a single surgeon. The device was installed onto the side rail of the operating table along with the clip applier attachment. After dissecting the cerebral artery segment proximal to the aneurysm, a temporary aneurysm clip was loaded and established at the appropriate segment before dissecting distally toward the aneurysm. RESULTS: Setup for the robotic arm and temporary clip was simple, quick, precise, and without any unforeseen accommodations needed in all 3 instances. The temporary clip acted as an emergency gate and could be deployed either manually or remotely through a controller. IAR occurred in case 1, and the robotic-assisted temporary clip deployment achieved immediate hemostasis without complications. This method bypassed the need for significant suctioning, packing, and further exploration for safe temporary clipping. Case 2 and 3 demonstrated the feasibility for middle cerebral artery protection and ease of intraoperative readjustment. CONCLUSION: This technical note highlights the feasibility and relative ease of using a robotic arm as a safeguard device, and it enables on-demand control of proximal blood flow and may enhance the safety of microsurgical aneurysm procedures.

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