Hydrocephalus is an abnormal buildup of cerebrospinal fluid (CSF) deep within the brain, resulting in clinical symptoms, including disorientation, vision disturbances, headaches, cognitive and developmental impairment [1].
Hydrocephalus can be simply divided into communicating and non-communicating subtypes. Communicating hydrocephalus is caused when there is an overproduction of CSF. Non-communicating hydrocephalus, on the other hand, occurs when there is a blockade of the pathway in the ventricular system, and CSF cannot normally proceed through the CNS.
Another classification is primary or secondary hydrocephalus. Primary hydrocephalus is a result of pathological fetal development, caused by various genetic factors [2], [3]. Secondary hydrocephalus can be a result of acute head injury, intracranial infection, or intracranial hemorrhage [4].
According to the systematic review performed by Isaacs et al., the prevalence of hydrocephalus is around 88 per 100,000 among children and 175 per 100,000 among the elderly [5]. Additionally, a lower incidence of this pathology was found among high-income countries.
There are various approaches for the management of hydrocephalus, including drug treatment and surgical procedures [6]. Surgical modalities include placement of an external ventricular drain (EVD), shunting (ventriculoperitoneal [VP], ventriculoatrial [VA], or lumboperitoneal [LP]), and endoscopic third ventriculostomy (ETV).
Both VP shunting and ETV are commonly used for the treatment of hydrocephalus. However, reliance on anatomical landmarks without assistance of navigation can lead to complications related to wrong trajectory of endoscope or catheter [7]. Therefore, an accurate navigation system is needed to prevent damage to healthy CNS structures.
Additionally, the ETV interventions may lead to fornical injuries, (hypo)thalamic contusion, nerve palsy, basilar artery damage, or neurological impairment when inaccurate endoscope manipulations are performed [8], [9], [10].
The neurosurgical field has undergone technological progress with the introduction of high-tech tools. Among them, neurosurgical robots have been applied in various neurosurgical and neuroradiological interventions, such as brain biopsy, cerebral aneurysm coiling, spinal instrumentation, deep brain stimulation surgery, stereoelectroencephalography surgery, and intracranial hemorrhage drain [11], [12], [13]. The aim of the robotic assistance (RA) technology is to provide a higher accuracy of the surgical procedures, through computer-assisted navigation and pre-operative planning.
With an increasing interest in robots in the neurosurgical field, to this date, no systematic review has analyzed the RA surgical management of hydrocephalus. We believe that this review provides a novel pathway and guidance, as we plan to analyze surgical approaches, complications of RA management, and clinical effectiveness. We also plan to provide advantages and disadvantages of robotic systems in the treatment of this neurological condition, compared to manual approaches.