Neurosurgical Robot-Assisted Navigation Enhances Precision in Bypass Surgery for Moyamoya Disease: A Study of Vascular Protection and Haemodynamic Optimization.

BACKGROUND

Despite improvements in revascularisation, precise donor vessel localization and haemodynamic optimization remain critical challenges in moyamoya disease (MMD) bypass surgery, especially for patients with pre-existing extracranial-intracranial (EC-IC) collaterals. This study evaluates the feasibility of neurosurgical robot-assisted navigation in addressing these challenges.

METHODS

Five consecutive MMD patients who received robot-assisted combined direct (STA-MCA) and indirect bypass from July to October 2023 were analysed retrospectively. Primary outcomes were intraoperative vessel injury rates and 12-month donor vessel patency on DSA/MRA.

RESULTS

All STA dissections (5/5) succeeded without MMA injury. Postoperative imaging showed no competitive flow or donor vessel occlusion. All patients exhibited improved cognitive scores and favourable clinical outcomes at 1-year follow-up.

CONCLUSION

Robot-assisted navigation enhances surgical precision in MMD through: Preserving EC-IC collaterals via millimetre-level trajectory planning and optimising anastomosis geometry to prevent competitive flow, which is important for patients with existing collaterals.