Robot-assisted endoscopic third ventriculostomy: institutional experience in 9 patients

Area of Science:

• Neurosurgery
• Medical Robotics
• Pediatric Neurology

Background:

• Endoscopic third ventriculostomy (ETV) is a standard treatment for obstructive hydrocephalus.
• Freehand endoscope control in ETV carries a significant risk of neural injury (up to 16.6%).
• The ROSA system offers stereotactic optimization of endoscope trajectories and stable mechanical support.

Observation:

• Nine pediatric patients (1.5-16 years) with favorable ETV Success Scores (≥70) underwent ETV using the ROSA system.
• Intracranial pathologies included tectal tumors, hydrocephalus, aqueductal stenosis, cysts, Chiari I malformation, and pineal masses.
• Robotic assistance evolved from ventricular access to full procedure support over 8 months.

Findings:

• All nine patients achieved successful ETV with the ROSA system, with no complications.
• Procedures were combined with other interventions like biopsies and decompression in four cases.
• A learning curve was observed, leading to shorter and more efficient surgical and registration times.

Implications:

• The ROSA system enables a stable, precise, and minimally invasive approach to ETV.
• Robotic assistance in ETV can potentially reduce the incidence of neural injuries.
• This technology may enhance outcomes for pediatric patients with obstructive hydrocephalus.