J Neurol Surg B Skull Base 2013; 74 - A175
DOI: 10.1055/s-0033-1336298

Robotic Navigation of the Infratemporal Fossa and Midline Cranial Base

Kofi Boahene 1(presenter), Raymond Blanco 1, Jeremy Richmon 1
  • 1Baltimore, MD, USA

Objective: With the expanding application of endoscopic techniques in skull base surgery, we conducted a feasibility preclinical study on robotic exploration of the infratemporal and midline cranial base using the Da Vinci robotic platform.

Method: Two cadaveric head specimens injected with latex were scanned for stereotactic navigation. A maxillary osteoplastic window was created removing the medial and lateral maxillary buttresses as a single bone flap. The Da Vinci robotic system was docked with various configurations of endoscope and working arm through the unilateral osteoplastic window. The pterygomaxillary space, infratemporal fossa, and nasal cavity midline cranial base were explored.

Result: The single unilateral maxillary osteoplastic window provided an adequate window for manipulation of the current Da Vinci system for exploration of the infratemporal fossa and midline cranial base. The 3-D view offered by the robotic system, as well as the tremor-free filtration, allowed very fine movement and tissue dissection. Suturing with the robotic system was feasible along the cranial base. Current instrument size was limiting in deeper dissection within the sphenoid sinus. Convention drilling instruments were necessary for bone removal.

Conclusion: The maxillary osteoplastic window offers an adequate window for robotic-assisted dissection of the infratemporal fossa and midline cranial base. When combined with conventional techniques, the robotic system can offer additional 3-D anatomic delineation and tremor-free filtration for delicate dissection along the skull base.