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[PMID]:28452710
[Au] Autor:Loftus PA; Wise SK; Daraei P; Baugnon K; DelGaudio JM
[Ad] Endereço:Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA.
[Ti] Título:Excavating meningoencephaloceles: A newly recognized entity.
[So] Source:Am J Rhinol Allergy;31(2):127-134, 2017 Mar 01.
[Is] ISSN:1945-8932
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Spontaneous cerebrospinal fluid (CSF) leaks are largely attributed to idiopathic intracranial hypertension and typically present as skull base defects with or without prolapse of intracranial contents. However, in our practice, we have encountered a distinct type of spontaneous CSF leak that presents in a different manner. OBJECTIVE: To discuss a newly-classified, difficult to treat, subset of spontaneous CSF leaks that present as excavation of the bone of the skull base in a tunnel- or canal-like fashion by a meningocele or meningoencephalocele instead of as a localized area of bony dehiscence. METHODS: A retrospective review was performed at a tertiary care rhinology practice to identify a subset of CSF leak patients with an excavating/canal-like skull base defect visualized radiographically on computed tomography (CT) scan or magnetic resonance imaging and/or endoscopically in the operating room. RESULTS: The cohort of patients consisted of 7 females and 1 male with an average age of 53.6 years and a self-reported race of 4:3:1 African-American:Caucasian:Indian. All patients presented with CSF rhinorrhea. The most common leak site was the cribriform and upper septum. Six of the 8 patients had multiple defects and/or progression of their skull base defects, and 5 patients required multiple and/or repeat repairs in the operating room. Seven of the 8 patients underwent a cisternogram because the excavating nature of the leaks made it difficult to identify the specific leak site on high-resolution CT scan alone. CONCLUSION: In spontaneous CSF leaks that are difficult to identify or recur soon after a proper repair, an excavating pattern should be considered. Failure to recognize this type of leak and all of its tributaries, to fully unroof the excavated bone to completely resect the meningocele, and to visualize and close the site of origin will likely result in failure and recurrence of CSF leak.
[Mh] Termos MeSH primário: Vazamento de Líquido Cefalorraquidiano/diagnóstico
Encefalocele/diagnóstico
Meningocele/diagnóstico por imagem
Base do Crânio/diagnóstico por imagem
Base do Crânio/patologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Vazamento de Líquido Cefalorraquidiano/cirurgia
Encefalocele/cirurgia
Endoscopia
Feminino
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Meningocele/cirurgia
Meia-Idade
Base do Crânio/cirurgia
Tomografia Computadorizada por Raios X
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.2500/ajra.2017.31.4413


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[PMID]:28452709
[Au] Autor:Al-Asousi F; Okpaleke C; Dadgostar A; Javer A
[Ad] Endereço:Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, St. Paul's Sinus Centre, University of British Columbia, Vancouver, British Columbia, Canada.
[Ti] Título:The use of polydioxanone plates for endoscopic skull base repair.
[So] Source:Am J Rhinol Allergy;31(2):122-126, 2017 Mar 01.
[Is] ISSN:1945-8932
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Many reconstructive techniques and materials have been reported for repair of skull base defects after sinonasal tumor excision, cerebrospinal fluid (CSF) leaks, and coverage of denuded bone. Synthetic materials have been developed for endoscopic skull base repair to avoid donor-site morbidity. Polydioxanone plate is a bioabsorbable implant designed for nasal septal reconstruction and has the ability to retain strength for at least 10 weeks and absorbs in 6 months. OBJECTIVES: This study aimed to describe the use of polydioxanone plates in endoscopic skull base defect and CSF leak repair, and to describe our experience with the surgical technique and postoperative management. METHODS: This was a retrospective case series of patients who, between May 2013 and December 2015, underwent endoscopic sinus surgery and skull base repair for CSF leak or after excision of a skull base tumor by using polydioxanone plates. Patients who presented with sinonasal inflammatory disease or skull base tumors underwent endoscopic skull base repair by using polydioxanone plates in an underlay fashion and mucosal membrane grafts with or without adjuvant materials in an overlay fashion. The patients were reviewed at 6 days, 6 weeks, and 3 months after surgery. Postoperative adverse events, including CSF leak, infection, bleeding, headache, and graft failure, were recorded. RESULTS: The cases of seven patients (five women, two men; mean age, 53.9 years) were reviewed. Five patients underwent sinonasal tumor resection and two underwent repair for CSF leak. The mean (standard deviation) defect size was 16.4 ± 11.4 mm. There was no evidence of postoperative CSF leak, and lumbar drains were not used. One patient reported transient headache and facial pressure at the 6-week follow-up visit. The surgeons' experience with polydioxanone plate placement, postoperative healing, and follow-up was satisfactory. CONCLUSION: Polydioxanone could be used to achieve rigid repair of endoscopic skull base defects. These early results, although promising, require validation in clinical trials.
[Mh] Termos MeSH primário: Implantes Absorvíveis/utilização
Vazamento de Líquido Cefalorraquidiano/cirurgia
Endoscopia
Seios Paranasais/cirurgia
Procedimentos Cirúrgicos Reconstrutivos
Neoplasias da Base do Crânio/cirurgia
Base do Crânio/cirurgia
[Mh] Termos MeSH secundário: Materiais Biocompatíveis/química
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Seios Paranasais/patologia
Polidioxanona/química
Complicações Pós-Operatórias
Estudos Retrospectivos
Base do Crânio/anormalidades
Base do Crânio/patologia
Neoplasias da Base do Crânio/patologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biocompatible Materials); 31621-87-1 (Polydioxanone)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.2500/ajra.2017.31.4411


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[PMID]:28452700
[Au] Autor:Ghadersohi S; Ference EH; Detwiller K; Kern RC
[Ad] Endereço:Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
[Ti] Título:Presentation, workup, and management of penetrating transorbital and transnasal injuries: A case report and systematic review.
[So] Source:Am J Rhinol Allergy;31(2):29-34, 2017 Mar 01.
[Is] ISSN:1945-8932
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A foreign body (FB) penetrating intracranially after passing transorbitally or transnasally is a rare occurrence. However, otolaryngologists are increasingly being asked to participate in the care of these patients for both endoscopic removal of the object and repair of any skull base defects. OBJECTIVE: To assess the presentation, workup, and management of transnasal or transorbital penetrating FB injury. METHODS: Systematic review of the presentation, workup, and management of transnasal or transorbital penetrating FB injury; plus, a case report of a 53-year-old woman with a transorbital penetrating rose bush branch. We searched medical literature data bases, which resulted in 215 total titles, which were then narrowed based on inclusion and exclusion criteria. RESULTS: Thirty-five cases of transorbital or transnasal low-velocity trauma that involved the paranasal sinuses were reviewed from 33 articles. The average age was 30 years, 40% of the objects were made of wood. Fifty-seven percent of the cases were transorbital, whereas 43% were transnasal. Forty-six percent of the surgical interventions were completed endoscopically or with endoscopic assistance. Complications of injury were common, with 66% of patients experiencing cerebrospinal fluid leaks; 23%, permanent blindness; 17%, meningitis; 14%, ophthalmoplegia; 9%, decreased visual acuity; and 3%, brain abscess. Our patient presented with a traumatic cerebrospinal fluid leak, and recovered well after transorbital and endoscopic removal of the branch, skull base repair, and a prolonged course of antibiotics and antifungal medications. CONCLUSIONS: Transnasal and transorbital penetrating FB injuries are a relatively uncommon occurrence but when they do occur require rapid workup and interdisciplinary management to prevent acute and delayed complications.
[Mh] Termos MeSH primário: Vazamento de Líquido Cefalorraquidiano/epidemiologia
Traumatismos Craniocerebrais/epidemiologia
Endoscopia
Traumatismos Oculares/epidemiologia
Traumatismos Cranianos Penetrantes/epidemiologia
Órbita/cirurgia
Seios Paranasais/cirurgia
Complicações Pós-Operatórias/epidemiologia
[Mh] Termos MeSH secundário: Vazamento de Líquido Cefalorraquidiano/etiologia
Traumatismos Craniocerebrais/cirurgia
Traumatismos Oculares/cirurgia
Feminino
Corpos Estranhos
Traumatismos Cranianos Penetrantes/cirurgia
Seres Humanos
Meia-Idade
Base do Crânio/cirurgia
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.2500/ajra.2017.31.4421


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[PMID]:29252993
[Au] Autor:Favier V; Zemiti N; Caravaca Mora O; Subsol G; Captier G; Lebrun R; Crampette L; Mondain M; Gilles B
[Ad] Endereço:Montpellier Laboratory of Informatics, Robotics and Microelectonics (LIRMM), ICAR team, French National Centre for Scientific Research (CNRS), Montpellier University, Montpellier, France.
[Ti] Título:Geometric and mechanical evaluation of 3D-printing materials for skull base anatomical education and endoscopic surgery simulation - A first step to create reliable customized simulators.
[So] Source:PLoS One;12(12):e0189486, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Endoscopic skull base surgery allows minimal invasive therapy through the nostrils to treat infectious or tumorous diseases. Surgical and anatomical education in this field is limited by the lack of validated training models in terms of geometric and mechanical accuracy. We choose to evaluate several consumer-grade materials to create a patient-specific 3D-printed skull base model for anatomical learning and surgical training. METHODS: Four 3D-printed consumer-grade materials were compared to human cadaver bone: calcium sulfate hemihydrate (named Multicolor), polyamide, resin and polycarbonate. We compared the geometric accuracy, forces required to break thin walls of materials and forces required during drilling. RESULTS: All materials had an acceptable global geometric accuracy (from 0.083mm to 0.203mm of global error). Local accuracy was better in polycarbonate (0.09mm) and polyamide (0.15mm) than in Multicolor (0.90mm) and resin (0.86mm). Resin and polyamide thin walls were not broken at 200N. Forces needed to break Multicolor thin walls were 1.6-3.5 times higher than in bone. For polycarbonate, forces applied were 1.6-2.5 times higher. Polycarbonate had a mode of fracture similar to the cadaver bone. Forces applied on materials during drilling followed a normal distribution except for the polyamide which was melted. Energy spent during drilling was respectively 1.6 and 2.6 times higher on bone than on PC and Multicolor. CONCLUSION: Polycarbonate is a good substitute of human cadaver bone for skull base surgery simulation. Thanks to short lead times and reasonable production costs, patient-specific 3D printed models can be used in clinical practice for pre-operative training, improving patient safety.
[Mh] Termos MeSH primário: Endoscopia/métodos
Modelos Anatômicos
Impressão Tridimensional
Base do Crânio/anatomia & histologia
Crânio/anatomia & histologia
[Mh] Termos MeSH secundário: Cadáver
Sulfato de Cálcio/química
Simulação por Computador
Seres Humanos
Nylons/química
Segurança do Paciente
Cimento de Policarboxilato/química
Reprodutibilidade dos Testes
Estresse Mecânico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Nylons); 0 (Polycarboxylate Cement); 25766-59-0 (polycarbonate); WAT0DDB505 (Calcium Sulfate)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189486


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[PMID]:28700740
[Au] Autor:Grauvogel TD; Engelskirchen P; Semper-Hogg W; Grauvogel J; Laszig R
[Ad] Endereço:Department of Otorhinolaryngology-Head and Neck Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
[Ti] Título:Navigation accuracy after automatic- and hybrid-surface registration in sinus and skull base surgery.
[So] Source:PLoS One;12(7):e0180975, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Computer-aided-surgery in ENT surgery is mainly used for sinus surgery but navigation accuracy still reaches its limits for skull base procedures. Knowledge of navigation accuracy in distinct anatomical regions is therefore mandatory. This study examined whether navigation accuracy can be improved in specific anatomical localizations by using hybrid registration technique. STUDY DESIGN: Experimental phantom study. SETTING: Operating room. SUBJECTS AND METHODS: The gold standard of screw registration was compared with automatic LED-mask-registration alone, and in combination with additional surface matching. 3D-printer-based skull models with individual fabricated silicone skin were used for the experiments. Overall navigation accuracy considering 26 target fiducials distributed over each skull was measured as well as the accuracy on selected anatomic localizations. RESULTS: Overall navigation accuracy was <1.0 mm in all cases, showing the significantly lowest values after screw registration (0.66 ± 0.08 mm), followed by hybrid registration (0.83± 0.08 mm), and sole mask registration (0.92 ± 0.13 mm).On selected anatomic localizations screw registration was significantly superior on the sphenoid sinus and on the internal auditory canal. However, mask registration showed significantly better accuracy results on the midface. Navigation accuracy on skull base localizations could be significantly improved by the combination of mask registration and additional surface matching. CONCLUSION: Overall navigation accuracy gives no sufficient information regarding navigation accuracy in a distinct anatomic area. The non-invasive LED-mask-registration proved to be an alternative in clinical routine showing best accuracy results on the midface. For challenging skull base procedures a hybrid registration technique is recommendable which improves navigation accuracy significantly in this operating field. Invasive registration procedures are reserved for selected challenging skull base operations where the required high precision warrants the invasiveness.
[Mh] Termos MeSH primário: Seios Paranasais/cirurgia
Base do Crânio/cirurgia
Cirurgia Assistida por Computador/métodos
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170927
[Lr] Data última revisão:
170927
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170713
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0180975


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[PMID]:28688556
[Au] Autor:Majumder A; Wick CC; Collins R; Booth TN; Isaacson B; Kutz JW
[Ad] Endereço:Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
[Ti] Título:Pediatric Langerhans cell histiocytosis of the lateral skull base.
[So] Source:Int J Pediatr Otorhinolaryngol;99:135-140, 2017 Aug.
[Is] ISSN:1872-8464
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Describe the presentation, imaging characteristics, management, and outcomes of pediatric patients with Langerhans cell histiocytosis (LCH) of the temporal bone. METHODS: A retrospective chart review was performed between 2000 and 2014 at a single tertiary care children's hospital. Fourteen patients were identified with a diagnosis of LCH and involvement of the temporal bone. RESULTS: Ten patients were female and ten were Caucasian. Mean age at diagnosis was 3 years (range 0.3-9.6 years). The most common presenting symptoms were scalp lesions, postauricular lesions, otalgia, and persistent ear infections. Three patients had documented hearing loss. Four cases had otic capsule invasion. Computed tomography demonstrated a lytic temporal bone lesion within the following subsites: mastoid, squamous temporal bone, external auditory canal, middle ear, and petrous apex. Four patients had intracranial disease. Extent and location of disease prompted all patients to be initially managed with chemotherapy. Surgical excision was limited to one case of localized recurrence. After a mean follow-up of 85.2 months (SD 42.4 months) there were no deaths but eight patients had a recurrence. Two patients developed long-term otologic sequelae requiring surgery. One patient developed labyrinthitis ossificans. CONCLUSION: LCH has a varied presentation, age distribution, and treatment algorithm. This series of 14 pediatric patients with temporal bone involvement supports a limited role for surgical resection. Long-term follow-up is critical for detection of local and disseminated disease, and for monitoring of otologic complications.
[Mh] Termos MeSH primário: Histiocitose de Células de Langerhans/diagnóstico
Base do Crânio/patologia
Osso Temporal/patologia
[Mh] Termos MeSH secundário: Doenças Ósseas/patologia
Criança
Pré-Escolar
Meato Acústico Externo/patologia
Feminino
Histiocitose de Células de Langerhans/complicações
Histiocitose de Células de Langerhans/terapia
Seres Humanos
Lactente
Masculino
Estudos Retrospectivos
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170710
[St] Status:MEDLINE


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[PMID]:28672709
[Au] Autor:Wang K; Zhang J
[Ad] Endereço:Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Brain Tumor, Beijing, China.
[Ti] Título:In Reply to the Letter to the Editor Regarding "Expression of Cathepsin K in Skull Base Chordoma".
[So] Source:World Neurosurg;103:930, 2017 07.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Catepsina K
Cordoma
[Mh] Termos MeSH secundário: Neoplasias de Cabeça e Pescoço
Seres Humanos
Base do Crânio
Neoplasias da Base do Crânio
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
EC 3.4.22.38 (Cathepsin K)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170705
[St] Status:MEDLINE


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[PMID]:28672710
[Au] Autor:Tian K; Wang L; Zhang J
[Ad] Endereço:Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
[Ti] Título:In Reply to the Letter to the Editor Regarding "Expression of Cathepsin K in Skull Base Chordoma".
[So] Source:World Neurosurg;103:931, 2017 07.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Catepsina K
Cordoma
[Mh] Termos MeSH secundário: Neoplasias de Cabeça e Pescoço
Seres Humanos
Base do Crânio
Neoplasias da Base do Crânio
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
EC 3.4.22.38 (Cathepsin K)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170705
[St] Status:MEDLINE


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[PMID]:28672708
[Au] Autor:Dai ZH; Hao DJ; Yang M
[Ad] Endereço:Department of Orthopedics, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China.
[Ti] Título:Letter to the Editor Regarding "Expression of Cathepsin K in Skull Base Chordoma".
[So] Source:World Neurosurg;103:927-929, 2017 07.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Catepsina K
Cordoma
[Mh] Termos MeSH secundário: Neoplasias de Cabeça e Pescoço
Seres Humanos
Base do Crânio
Neoplasias da Base do Crânio
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
EC 3.4.22.38 (Cathepsin K)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170705
[St] Status:MEDLINE


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[PMID]:28645603
[Au] Autor:Bolzoni Villaret A; Doglietto F; Carobbio A; Schreiber A; Panni C; Piantoni E; Guida G; Fontanella MM; Nicolai P; Cassinis R
[Ad] Endereço:Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
[Ti] Título:Robotic Transnasal Endoscopic Skull Base Surgery: Systematic Review of the Literature and Report of a Novel Prototype for a Hybrid System (Brescia Endoscope Assistant Robotic Holder).
[So] Source:World Neurosurg;105:875-883, 2017 Sep.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Although robotics has already been applied to several surgical fields, available systems are not designed for endoscopic skull base surgery (ESBS). New conception prototypes have been recently described for ESBS. The aim of this study was to provide a systematic literature review of robotics for ESBS and describe a novel prototype developed at the University of Brescia. METHODS: PubMed and Scopus databases were searched using a combination of terms, including Robotics OR Robot and Surgery OR Otolaryngology OR Skull Base OR Holder. The retrieved papers were analyzed, recording the following features: interface, tools under robotic control, force feedback, safety systems, setup time, and operative time. A novel hybrid robotic system has been developed and tested in a preclinical setting at the University of Brescia, using an industrial manipulator and readily available off-the-shelf components. RESULTS: A total of 11 robotic prototypes for ESBS were identified. Almost all prototypes present a difficult emergency management as one of the main limits. The Brescia Endoscope Assistant Robotic holder has proven the feasibility of an intuitive robotic movement, using the surgeon's head position: a 6 degree of freedom sensor was used and 2 light sources were added to glasses that were therefore recognized by a commercially available sensor. CONCLUSIONS: Robotic system prototypes designed for ESBS and reported in the literature still present significant technical limitations. Hybrid robot assistance has a huge potential and might soon be feasible in ESBS.
[Mh] Termos MeSH primário: Neuroendoscopia
Procedimentos Cirúrgicos Robóticos
Robótica
Base do Crânio/cirurgia
[Mh] Termos MeSH secundário: Cadáver
Seres Humanos
Duração da Cirurgia
Papel do Médico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170625
[St] Status:MEDLINE



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