Robotic placement of a CNS ventricular reservoir for administration of chemotherapy.
The application of robotic technology to surgery holds great promise for improving surgical outcomes and reducing morbidity. We hypothesized that image-guided, robotic placement of a CNS ventriculostomy reservoir for intraventricular chemotherapy is safe, highly accurate, and highly reproducible. Eleven patients requiring catheter ventriculostomy for reservoir placement were included in this retrospective study. All underwent image-guided, robotic placement of a ventricular catheter, using a pre-operatively defined trajectory. All catheters entered the targeted structure. There were no catheter-related hemorrhages and no injury to adjacent neural structures. Mean distance of the catheter tip from target was 1.6 mm. Mean operative time was 42.8 minutes. Robotic placement of a reservoir ventriculostomy using a pre-planned trajectory is safe, highly accurate, and highly reliable. This makes single-pass ventriculostomy possible in nearly all patients, even those with very small ventricles, and may permit catheter-based therapies in patients who would otherwise be deemed poor surgical candidates by virtue of ventricular size. It also permits careful pre-operative study and optimization of the catheter trajectory, which may be beneficial in minimizing risk to bridging veins and sulcal vessels.
Lollis
S Scott
SS
Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA. Scott.Lollis@hitchcock.org
Roberts
David W
DW
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002404:Catheterization / Q000295:instrumentation / Q000379:methods; D016543:Central Nervous System Neoplasms / Q000188:drug therapy*; D004343:Drug Implants; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics; D013238:Stereotaxic Techniques / Q000295:instrumentation; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000295:instrumentation* / Q000379:methods; D055815:Young Adult
D000970:Antineoplastic Agents; D004343:Drug Implants