Feasibility and accuracy of CARLO© guided optic canal unroofing

Abstract

The surgical procedure known as optic nerve unroofing plays a vital role in skull base surgery. This critical intervention focuses on relieving pressure and decompressing the optic nerve to safeguard vision, restore optimal nerve function, and enhance the surgical view during aneurysm therapy. Nevertheless, the surgical procedure presents inherent challenges and risks due to factors like limited working space, restricted surgical view, and the proximity to critical anatomical structures, including the optic nerve, carotid artery and oculomotor nerve. Significant advancements in medical robotics technology hold promise for addressing these challenges and potentially enhancing multiple aspects of neurosurgery. The objective of this study was to evaluate the feasibility and precision of utilizing CARLO© (Cold Ablation Roboterguided Laser Osteotome) for delineating the boundaries of the optical canal. Additionally, the investigation involved the insertion of a thermal probe into the optical canal to assess the occurrence of significant heat damage resulting from the removal of the optic roof. Success was defined as the accurate excavation of the optical canal, which was confirmed through post-experimental CT scans and photographic documentation. The experiment utilized five fresh frozen skulls, securely fixed in a Mayfield clamp to ensure a stable experimental setup. Prior to the procedure, preoperative planning was conducted using NeuroPlan©, which accurately segmented crucial anatomical structures and devised trajectories with a safety margin of 2mm from high-risk areas. A navigation system and additional referencing screws were employed to achieve precise bone ablation. The target structure was accessed through a pterional craniotomy and the optical canal was prepared extradurally. While data evaluation is ongoing, preliminary results indicate a successful delineation of the optical roof without significant heat damage while preserving vital anatomical structures. These initial findings have the potential to stimulate further investigation into the applications of robotic and laser technologies in the realm of neurosurgery. The study emphasizes the feasibility and exceptional precision of robotic technology, which can be utilized to advance the development of additional procedures to improve patient outcomes and reduce perioperative risks in neurosurgical interventions.

Keywords

• optic canal unroofing
• skull base surgery
• er: yag laser
• cold ablation
• carlo
• roboter-guided surgery