Neurosurgical robot-assisted transnasal endoscopic surgery in orbital-related diseases

Transnasal endoscopic surgery, with its minimal invasiveness and no facial incisions, is increasingly used for orbital-related diseases. Robot-assisted techniques enhance precision, safety, and efficacy, offering significant advantages in treating these complex conditions involving multiple anatomical structures and nterdisciplinary considerations.

This study reports our experience using robot-assisted transnasal endoscopic surgery for orbital-related diseases.

We retrospectively analyzed 162 patients (March 2021-July 2024) with orbital-related diseases who underwent robot-assisted transnasal endoscopic surgery: 137 optic nerve injuries, 8 orbital tumors, 8 cranio-orbital communication tumors, 5 orbital abscesses, 4 orbital foreign bodies. Outcomes were assessed via clinical follow-up and imaging.

161 cases achieved satisfactory treatment without serious complications except for one patient underwent endovascular embolization due to intraoperative bleeding caused by pseudoaneurysm rupture. Among optic nerve injury patients, 66/137 (48.18 %) presented with vision improvement, (36/90 (40 %) were effective in those without light perception, 8/11 (72.73 %) were effective in those with light perception, and 22/36 (61.11 %) were effective in those with better light perception). A 100 % removal rate was achieved in orbital tumors, orbital peripheral abscesses, and foreign bodies. 6/8 (75 %) of cranial-orbital communication tumors were resected completely with the remaining two cases identified pathologically as melanoma and lymphoma.

Robot-assisted transnasal endoscopic surgery is a safe, effective and minimally invasive technique, showing potential advantages in procedures of orbital-related diseases such as optic nerve canal decompression, tumor resection, abscess drainage, and foreign body removal. Preoperative vascular-related examinations can be helpful to reduce the surgery-related complications.