The Role of Robotic Surgery in Sinonasal and Ventral Skull Base Malignancy

Robotic surgical systems are used worldwide in various fields. In this study, we present the advantages and disadvantages of the most common robotic surgical system, the da Vinci Xi system, in the supracerebellar transtentorial approach to the mesial temporal region and discuss options for its integration into neurosurgery.

Our study was conducted at the Advanced Simulation and Applied Endoscopic Surgery Training and Research Center and Anatomy Laboratory. Four formalin-fixed human cadaveric head specimens with red silicone dye injected into their arterial structures and blue silicone dye injected into their venous structures were used in the study. Dissections were performed in microscopic and robotic stages. All phases were photographed using a three-dimensional photographic technique.

The mesial temporal lobe could be accessed via the supracerebellar transtentorial route with the use of the robotic system. We show that the robotic system can be used in difficult approaches and narrow regions with a wider exposure and superior image quality than with the microscopic approach, improving the ergonomics for the surgeon. The shortcomings of robotic systems are examined and innovative solutions are offered.

This study shows the advantages and disadvantages of the robotic surgical approach to the mesial temporal region via the supracerebellar transtentorial route. Robotic surgical systems can play a major role in neurosurgical practices with the tools designed and the innovative solutions determined in this study. Nevertheless, further research and development of these systems and related instruments are necessary to ensure their wider implementation in neurosurgery.

The purposes were to investigate the postoperative, long-term quality of life (QoL) of patients with maxillofacial malignancies who underwent craniofacial resections that involved the skull base and to screen for potential predictors of QoL.

We reviewed all patients who had undergone craniofacial resections as identified by the electronic medical record system from 2013 onward; we then applied our eligibility criteria to generate the study cohort. Each patient was asked to complete the Skull Base Inventory, a questionnaire that is scored from 0 to 100, during his or her regular postoperative follow-up. All demographic information and clinicopathologic variables were then collected and analyzed.

A total of 25 patients who received treatment between March 2013 and March 2018 were consecutively enrolled and surveyed at 6 to 42 months (median, 15 months). The age at diagnosis ranged from 23 to 81 years (median, 42 years), with a female-to-male ratio of 1.1:1.0. The mean score for QoL was 67.56 ± 16.35. Univariate analysis found that being in the subgroup aged 20 to 40 years (β = –12.87 [95% confidence interval (CI), –25.54 to –0.21], P = .047), having the mesenchymal pathologic subtype (β = –18.80 [95% CI, –34.05 to –3.54], P = .018), and having involvement of the middle skull base (β = –15.00 [95% CI, –28.33 to –1.68], P = .029) could all significantly impact long-term QoL. A multiple linear regression model (R² = 36.4%, P = .007) included the latter 2 factors (β = –16.82 [95% CI, –31.06 to –2.59], P = .023, and β = –13.14 [95% CI, –25.35 to –0.94], P = .036, respectively).

The location of the involved skull base may be used as a guide for the surgical approach or incision design to improve patients' long-term QoL. However, this should not take precedence over the nature of malignancies as the pathologic subtype implied that patients with mesenchymal malignancies may pay the price of better QoL to survive.