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.