The Benefits of the Prone Position During Robotic Neurosurgery

Flexibility is a crucial factor for neurosurgeons, especially during the pre-planning stages of neurosurgery. The decision regarding the entry point for craniotomy can be made based on whether the patient is in a supine or prone position.

Ph.D. MD. Stanley Chuang (Hao-Yu, Chuang) is the Chief of the Neuro-Medical Scientific Center at An-Nan National Hospital, whose research interests include neuro-oncology, neuro-regenerative medicine, and medical engineering. He is focusing on brain tumor surgery, cerebrovascular surgery, spine surgery, and neuro-functional surgery. According to Dr. Chuang, navigation systems often utilize reference markers on the forehead, typically special position markers or imaging markers combined with MRI or CT scans, to determine surgical location and depth. He also shared his clinical experience with NaoTrac, a neurosurgical navigation robot, during the EANS (The European Association of Neurosurgical Societies) 2023 conference in Barcelona, Spain. 

In his interview, Dr. Chuang highlights the advantages of the prone position during neurosurgery using NaoTrac.

What is the Significant Differences Between Supine and Prone Position Using Navigation Assisting on a Brain Tumor Biopsy Operation?

The accuracy and safety of these procedures depend not only on the surgeon’s skill and experience but also on the quality of images, equipment, and tools. Neurosurgeons often divide brain lesions into some anatomic parts of the brain. Similar to the anterior, middle, and posterior fossa, we also define the superior and inferior cerebellar tentorial areas.

The choice of surgical approach and path depends on the lesion’s location, which dictates the patient’s surgical positioning. Lesions near the anterior or middle fossa are generally feasible for surgery in the supine position. However, lesions in the posterior fossa or infra-tentorial area often require the prone position.

What are The Benefits of Performing Robotic Neurosurgery with NaoTrac for Prone Position Compared to Other Solutions?

Navigation systems play a crucial role in brain surgeries, assisting surgeons in accurate positioning and guiding surgical tools for precise procedures. The application of navigation systems differs between supine and prone surgeries. In supine surgery, navigation systems typically use reference markers on the forehead, usually special positioning markers or imaging markers combined with MRI or CT scans. Conversely, navigation systems utilize head reference markers in prone position surgery but require different positioning and calibration for accurate navigation.   

While traditional brain stereotactic and navigation systems rely on coordinate positioning and the concept of 3D space, the NaoTrac system utilizes vision-assisted image positioning, similar to the navigation method of Google Street View mapping.

The Outcome of Utilizing NaoTrac in Assisting Neurosurgery

At An-Nan Hospital, we have utilized the NaoTrac system in more than 10 patients for prone surgeries. Our experience has shown that the accuracy and precision of the NaoTrac system yield remarkable results, as shared during the EANS 2023 conference. It provides increased flexibility for neurosurgeons during surgery, and I wholeheartedly recommend NaoTrac to my colleagues in the field.”