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How I do it? Surgical removal of a corpus callosum arteriovenous malformation using a robotic digital microscope

  • How I Do it
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Abstract

Background

This report described the surgical nuance of a challenging deep-seated corpus callosum arteriovenous malformation (AVM) using a novel robotic digital microscope.

Method

A 64-year-old male was admitted to treat a ruptured corpus callosum AVM. In order to facilitate surgical manipulation under the robotic digital microscope, a gravity-assisted supine position was utilized. Intraoperatively, identifying and preserving the transit and bystander artery is important while skeletonizing the anterior cerebral artery. The nidus was totally resected and the patient was discharged without sequella.

Conclusion

It is feasible to perform complicated AVM resection under the robotic digital microscope with a rigorous surgical plan.

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Acknowledgements

This study was sponsored by the CAMS Innovation Fund for Medical Sciences (CIFMS, 2019-I2M-5-008), the National Natural Science Foundation of China (No. 82201461), the Shanghai Sailing Program (No. 22YF1404500), Pudong New Area Science and Technology Development Fund(No. PKX2020-R03) , and the Fujian Province Science and Technology Innovation Joint Fund (No. 2021Y9135).

Author information

Author notes

  1. Xingfen Su, Zhicheng Wang and Zixiao Yang contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, Fujian, China

    Xingfen Su & Zhicheng Wang

  2. Department of Neurosurgery, National Regional Medical Center, The First Affiliated Hospital Binhai Campus, Fujian Medical University, Fuzhou, 350209, Fujian, China

    Xingfen Su & Zhicheng Wang

  3. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Zhong Road, Shanghai, 200040, China

    Zixiao Yang & Jianping Song

  4. National Center for Neurological Disorders, Shanghai, 200040, China

    Zixiao Yang & Jianping Song

  5. Neurosurgical Institute of Fudan University, Shanghai, 200040, China

    Zixiao Yang & Jianping Song

  6. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China

    Zixiao Yang & Jianping Song

  7. Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China

    Zixiao Yang & Jianping Song

  8. Research Unit of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences (CAMS), Shanghai, 200040, China

    Zixiao Yang & Jianping Song

  9. Department of Neurosurgery, National Regional Medical Center, Huashan Hospital Fujian Campus, Fudan University, Fuzhou, 350209, Fujian, China

    Zixiao Yang & Jianping Song

Authors
  1. Xingfen Su
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  2. Zhicheng Wang
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  3. Zixiao Yang
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  4. Jianping Song
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Corresponding author

Correspondence to Jianping Song.

Ethics declarations

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by Huashan Hospital Institutional Review Board (HIRB), Fudan University, Shanghai, China

Informed consent

It represents a video of a surgical case. The patient gave approval for this publication

Conflict of interest

The authors declare no competing interests.

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Key points

1. The surgical removal of a challenging deep-seated corpus callosum AVM should be well-planned perioperatively.

2. The preoperative instruments setup aims to achieve the optimal ergonomics of the robotic digital microscope. .

3. Deliberate practice is an effective method for improving the performance of manipulating the robotic digital microscope .

4. The gravity-assisted supine position is beneficial to achieve brain autoretratcion.

5. The neuronavigation system is essential to determine the optimal surgical trajectory without violating the frontal bridging veins.

6. The lock-on-target function can help the camera return to saved targets efficiently when moving around the robotic digital microscope.

7. Identifying and preserving the transit and bystander artery is important while dissecting the AVM nidus.

8. It is critical to secure the feeders of the AVM nidus before transecting the drainage veins.

9. The ICGVA helps confirm the patency of ACA, its major branches, and the residue nidus.

10. It is feasible to perform complicated AVM resection under the robotic digital microscope with a rigorous surgical plan.

Supplementary Information

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Supplementary file1 (MP4 55179 KB)

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Su, X., Wang, Z., Yang, Z. et al. How I do it? Surgical removal of a corpus callosum arteriovenous malformation using a robotic digital microscope. Acta Neurochir 165, 1609–1613 (2023). https://doi.org/10.1007/s00701-023-05574-x

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  • DOI: https://doi.org/10.1007/s00701-023-05574-x

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