Background and Objectives: Robotic-assisted surgery (RS) has progressively emerged as a promising technology in modern thoracolumbar spinal surgery, offering the potential to enhance accuracy and improve clinical outcomes. To date, the benefits of robot-assisted techniques in thoracolumbar spinal surgery remain controversial. The objective of this study was to assess the efficacy and safety of RS compared to fluoroscopy-assisted surgery (FS) in spinal fusion procedures. Materials and Methods: In accordance with the PRISMA guidelines, a systematic review and meta-analysis was conducted, using REVMAN V5.3 software. The review protocol was registered in the Prospective Register of Systematic Reviews (PROSPERO) website with the following registration number: CRD42024567193. Results: Eighteen studies were included in the meta-analysis with a total of 1566 patients examined. The results demonstrated a worse accuracy in FS in cases with major violations of the peduncular cortex (D–E grades, according to Gertzbein’s classification) [(odds ratio (OR) 0.47, 95%-CI 0.28 to 0.80, I² 0%]. In addition, a lower complication rate was shown in the RS group compared to the FS group, specifically regarding the need for surgical revision due to screw mispositioning (OR 0.28-CI 0.17 to 0.48, I² 98%). Conclusions: Advantages of robot-assisted techniques were demonstrated in terms of postoperative complications, revision surgery rates, and the accuracy of screw placement. While RS represents a valuable and promising technological advancement in thoracolumbar spinal surgery, future studies are needed to further explore its advantages in thoracolumbar spinal surgery and to identify which spinal surgical approach has greater advantages when using the robot.

Autops Case Rep, vol.12, e2021394, 2022

The robot-assisted cortical bone trajectory (CBT) screw placement is safer than the traditional fluoroscopy-assisted approach. This is the first technical note reporting a novel technique of robot-assisted CBT screws placement with a subfascial transmuscular approach. After a lumbar interbody cage position, the second step consists in the robot-assisted placement of CBT screws in a prone position. A median skin incision is performed, ensuring an incision as small as possible. CBT screw direction and trajectory are planned on the sterile robot touchscreen display. A navigated drill is used to breach the cortical surface of the entry point. Then, a navigated drill bit is used to complete the exposure of the screw trajectory. The screw is placed with the support of the robotic arm. In the single-position the surgical field must be prepared since the first surgical step. All the navigation references are placed on the same iliac crest. The following steps resemble the ones described for the double-position. This is the first reported technical note about robot-assisted transmuscular CBT screw placement for posterior fixation in LLIF. The surgical technique proposed aims to combine the advantages of CBT screws and the use of innovative robot-assisted technology.

In surgical practice during endoscopic endonasal approach (EEA), Growth Hormone-secreting Pituitary Neuroendocrine Tumors (GH-secreting PitNET) patients show morphologic differences in the nasal cavities and sinuses, leading to a narrower surgical field and a carotid prominence and potentially increasing the complexity of the surgical and the risk of complications. The aim of the study is to evaluate the anatomical differences of the sphenoid sinus between patients with GH-secreting PitNETs and patients with non-functioning Pituitary Neuroendocrine Tumors (NF-PitNET) underwent EEA. This is a monocentric retrospective study conducted at author's institution. The minimum intercarotid distance (ICS), the largest diameter of the sphenoid sinus (DSS) and the distance between vomer and clivus (VCD) were collected and compared. Presence, localization and course of intersphenoid sinus septum (ISS) were also evaluated. 100 consecutive patients were identified: 57 males (57%) and 43 females (43%), with a mean age of 55 years. 60 patients had NF-PitNET (60%) and 40 had GH-secreting PitNET (40%). GH-secreting PitNET group presented inferior values of ICD (16.8±3.94 mm vs. 20.4±3.94 mm, p<0.001), DSS (32.5±9.81 mm vs. 38.6±11.03 mm, p=0.006) and VCD (25.5±6.96 mm vs. 29.6±8.47 mm, p=0.012) compared to NF-PitNET group. ISS showed no differences between the two groups. ICD, DSS and VCD resulted smaller in acromegalic patients, confirming that patients with GH-secreting PitNETs have a narrower surgical field. A meticulous anatomical preoperative planning and neuronavigation are important to recognize the sphenoid anatomical landmarks in order to reduce the risk of complications, especially in acromegalic patients.

Background/Objectives: Peripheral nerve tumours are commonly encountered in clinical practice. Although most are benign, a subset can exhibit aggressive and invasive behaviour, evolving into malignant peripheral nerve sheath tumours (MPNSTs). Due to their rarity and overlapping features with benign lesions, MPNSTs are frequently misdiagnosed during the initial evaluation. Preoperative biopsy may aid in distinguishing malignant from benign lesions. This single-center study aimed to develop and validate a diagnostic algorithm—based on a systematic literature review and institutional case series—to assess the role of preoperative biopsy in the diagnostic workflow. Methods: A systematic review of the literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, covering the period from 1998 to 2024. Additionally, a retrospective case series of patients with peripheral nerve lesions treated at the authors’ institution between January 2018 and June 2024 was analysed. Results: Forty-eight articles met the inclusion criteria and were categorized into five key domains: radiological features of MPNSTs, associated risk factors and genetic conditions, the role of preoperative biopsy, use of radiotherapy, and general clinical management strategies. The proposed diagnostic algorithm was applied to a series of 36 patients, four of whom met the criteria for preoperative biopsy. In three of these cases, early diagnosis of MPNSTs was achieved. Conclusions: Preoperative biopsy appears to be a safe and cost-effective tool for the early identification of MPNSTs. Early diagnosis may facilitate the use of neoadjuvant therapies—such as radiotherapy or chemotherapy—potentially enabling more radical surgical resection and improving overall patient outcomes.

Invasion of deep structures of the skull by scalp lesions is a rare complication associated with these pathological entities. The management of tissue invasion is not well-defined. Reconstruction of the skin and skull defects is often challenging, and a multidisciplinary approach is essential. The aim of this study is to analyze the surgical options for managing bone and meningeal infiltration by scalp tumors and to propose a therapeutic algorithm. This single-center retrospective study included 10 patients with recalcitrant scalp tumors who underwent surgical treatment between 2019 and 2023. Clinical data were recorded, and outcome measures included duration of hospitalization, extent of tumor invasion into underlying tissues, lesion localization, surgical complications, potential adjuvant therapies, recurrence, and postoperative follow-up. A wide scalp incision around the lesion was performed in all cases. Skull infiltration was confirmed in all patients, necessitating resection of the infiltrated cranial bone with a 0.5-cm margin of healthy tissue. Meningeal infiltration was observed in 3 patients, requiring resection and subsequent duroplasty. In these cases, the resulting defect was reconstructed using polymethylmethacrylate cranioplasty and a fasciocutaneous flap. In 7 patients, a dermal substitute (Integra) was temporarily placed and later replaced with an autologous skin graft. Dura mater involvement is a critical factor to consider during surgical planning. Given the advanced age of patients affected by this condition, a less invasive approach using dermal substitutes for defect coverage is recommended whenever feasible.