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Neuronavigation Applied to Piezosurgery: Toward Robotic Image-Aided Craniotomy? A Technical Note.

Paolo Ferroli1, Guglielmo Iess2, Giulio Bonomo2

  • 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.

World Neurosurgery
|November 20, 2021
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Summary

Neuronavigated piezosurgery (PS) for craniotomy reduces complications. This technique allows real-time visualization, preventing dural lacerations and neurovascular injuries during skull bone cutting.

Keywords:
CraniotomyNeuronavigationPiezosurgeryRobotic-aidedVenous sinus injury

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Area of Science:

  • Neurosurgery
  • Surgical Technology

Background:

  • Craniotomy, while conceptually simple, carries risks of serious patient complications.
  • Piezosurgery (PS) offers an alternative bone-cutting method using microvibrations.
  • Despite PS benefits, risks like dural lacerations and neurovascular injuries persist due to potential inner bone penetration.

Purpose of the Study:

  • To evaluate the safety and efficacy of neuronavigated piezosurgery in craniotomy.
  • To assess the potential of neuronavigation to mitigate complications associated with piezosurgery.

Main Methods:

  • Two cases of miniretromastoid craniotomy for trigeminal neuralgia were performed using neuronavigated PS.
  • Preoperative imaging included volumetric brain MRI and CT scans.
  • The piezosurgical instrument was registered with the StealthStation neuronavigation system.

Main Results:

  • Neuronavigation enabled real-time visualization of the piezosurgical blade's depth during bone cutting.
  • No dural lacerations or neurovascular injuries were reported in the cases.
  • Bone flaps were repositioned accurately without fixation devices.

Conclusions:

  • Neuronavigated piezosurgery shows potential for reducing craniotomy-related complications.
  • Real-time visualization aids surgeons in preventing critical injuries.
  • This technique may pave the way for future robotic-assisted surgical procedures.