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Objective: The utility of robotic instrumentation is expanding in neurosurgery. Despite this, successful examples of robotic implementation for endoscopic endonasal or skull base neurosurgery remain limited. Therefore, the authors performed a systematic review of the literature to identify all articles that used robotic systems to access the sella or anterior, middle, or posterior cranial fossae., Methods: A systematic review of MEDLINE and PubMed in accordance with PRISMA guidelines performed for articles published between January 1, 1990, and August 1, 2021, was conducted to identify all robotic systems (autonomous, semiautonomous, or surgeon-controlled) used for skull base neurosurgical procedures. Cadaveric and human clinical studies were included. Studies with exclusively otorhinolaryngological applications or using robotic microscopes were excluded., Results: A total of 561 studies were identified from the initial search, of which 22 were included following full-text review. Transoral robotic surgery (TORS) using the da Vinci Surgical System was the most widely reported system (4 studies) utilized for skull base and pituitary fossa procedures; additionally, it has been reported for resection of sellar masses in 4 patients. Seven cadaveric studies used the da Vinci Surgical System to access the skull base using alternative, non-TORS approaches (e.g., transnasal, transmaxillary, and supraorbital). Five cadaveric studies investigated alternative systems to access the skull base. Six studies investigated the use of robotic endoscope holders. Advantages to robotic applications in skull base neurosurgery included improved lighting and 3D visualization, replication of more traditional gesture-based movements, and the ability for dexterous movements ordinarily constrained by small operative corridors. Limitations included the size and angulation capacity of the robot, lack of drilling components preventing fully robotic procedures, and cost. Robotic endoscope holders may have been particularly advantageous when the use of a surgical assistant or second surgeon was limited., Conclusions: Robotic skull base neurosurgery has been growing in popularity and feasibility, but significant limitations remain. While robotic systems seem to have allowed for greater maneuverability and 3D visualization, their size and lack of neurosurgery-specific tools have continued to prevent widespread adoption into current practice. The next generation of robotic technologies should prioritize overcoming these limitations.

Background: Novel methodologies providing realistic simulation of the neurosurgical operating room environment are currently needed, particularly for highly subspecialized operations with steep learning curves, high-risk profiles, and demands for advanced psychomotor skills., Objective: To describe the development of a curriculum for using perfusion-based cadaveric simulation models in a "Mock Operating Room" for neurosurgical procedures., Methods: At the USC Keck School of Medicine Fresh Tissue Dissection Laboratory between 2012 and 2016, 43 cadaveric specimens underwent cannulation of the femoral or carotid artery and artificial perfusion of the arterial system, and/or cannulation of the intradural cervical spine for intrathecal reconstitution of the cerebrospinal fluid (CSF) system. Models were used to train neurosurgical residents in various procedures. Self-assessment of pre- and postprocedure trainee confidence (Likert) scores was compared for each module., Results: The following novel procedural training methodologies were successfully established: management of an injury to the carotid artery during an endoscopic endonasal approach (n = 12), endoscopic endonasal CSF leak repair (n = 6) with fluorescein perfusion, carotid endarterectomy (n = 4), extracranial-to-intracranial bypass (n = 2), insertion of ventriculostomy catheter (n = 7), spinal laminectomy with durotomy repair (n = 9), and intraventricular neuro-endoscopy with septum pellucidotomy and third ventriculostomy (n = 12). In all instances, trainees reported improvement in their postprocedural confidence scores, with mean pre- and postprocedural Likert scores being 2.85 ± 1.09 and 4.14 ± 0.93 (P < .05)., Conclusion: Augmentation of fresh cadaveric specimens via reconstitution of vascular and CSF pathways is a feasible methodology for complimenting surgical training in numerous neurosurgical procedures, and may hold implications in the future of neurosurgical resident education., (Copyright © 2017 by the Congress of Neurological Surgeons)

Background and Purpose: Neuroendovascular surgery is a medical subspecialty that uses minimally invasive catheter-based technology and radiological imaging to diagnose and treat diseases of the central nervous system, head, neck, spine, and their vasculature. To perform these procedures, the practitioner needs an extensive knowledge of the anatomy of the nervous system, vasculature, and pathological conditions that affect their physiology. A working knowledge of radiation biology and safety is essential. Similarly, a sufficient volume of clinical and interventional experience, first as a trainee and then as a practitioner, is required so that these treatments can be delivered safely and effectively., Methods: This document has been prepared under the aegis of the Society of Neurological Surgeons and its Committee for Advanced Subspecialty Training in conjunction with the Joint Section of Cerebrovascular Surgery for the American Association of Neurological Surgeons and Congress of Neurological Surgeons, the Society of NeuroInterventional Surgery, and the Society of Vascular and Interventional Neurology., Results: The material herein outlines the requirements for institutional accreditation of training programs in neuroendovascular surgery, as well as those needed to obtain individual subspecialty certification, as agreed on by Committee for Advanced Subspecialty Training, the Society of Neurological Surgeons, and the aforementioned Societies. This document also clarifies the pathway to certification through an advanced practice track mechanism for those current practitioners of this subspecialty who trained before Committee for Advanced Subspecialty Training standards were formulated., Conclusions: Representing neuroendovascular surgery physicians from neurosurgery, neuroradiology, and neurology, the above mentioned societies seek to standardize neuroendovascular surgery training to ensure the highest quality delivery of this subspecialty within the United States., (© 2017 American Heart Association, Inc.)

The extradural anterior transpetrosal approach possesses several advantages. First, the majority of the dissection is extradural, providing protection to the overlying neural structures. Second, only limited retraction of the temporal lobe is necessary, protecting venous outflow via the vein of Labbe'. Third, transposition of cranial nerves or vascular structures in unnecessary. Fourth, it enjoys natural compatibility with other surgical approaches to enhance exposure of the posterior cavernous sinus and petroclival region. The disadvantages are mostly related to the unfamiliar anatomy. Most surgeons are not accustomed to visualizing petrous apical anatomy from the middle fossa orientation. Therefore, practice of this technique in the cadaver laboratory is a mandatory prerequisite to its performance in the operating room. The cochlea, carotid artery, labyrinth, and cranial nerves five through eight are all at risk during drilling and dissection. When performed properly, this technique provides a solid adjunct to treating complex lesions of the central cranial base.