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Objective Advanced transnasal sinus and skull base surgery remains a challenging discipline for head and neck surgeons. Restricted access and space for instrumentation can impede advanced interventions. Thus, we present the combination of an innovative robotic endoscope guidance system and a specific endoscope with adjustable viewing angle to facilitate transnasal surgery in a human cadaver model. Materials and Methods The applicability of the robotic endoscope guidance system with customfoot pedal controller was tested for advanced transnasal surgery on a fresh frozen human cadaver head. Visualization was enabled using a commercially available endoscope with adjustable viewing angle (15-90 degrees). Results Visualization and instrumentation of all paranasal sinuses, including the anterior and middle skull base, were feasible with the presented setup. Controlling the robotic endoscope guidance system was effectively precise, and the adjustable endoscope lens extended the view in the surgical field without the common change of fixed viewing angle endoscopes. Conclusion The combination of a robotic endoscope guidance system and an advanced endoscope with adjustable viewing angle enables bimanual surgery in transnasal interventions of the paranasal sinuses and the anterior skull base in a human cadaver model. The adjustable lens allows for the abandonment of fixed-angle endoscopes, saving time and resources, without reducing the quality of imaging. [ABSTRACT FROM AUTHOR]

Background: Parenchymal hemorrhage is one of the most feared risks of stereotactic brain biopsies potentially resulting in neurological deficits or even a fatal outcome. Patients with disorders of the coagulation system are at particular risk, so identifying these is one of the main tasks prior to surgery. Some patients may have a bleeding tendency despite normal laboratory values of the hemostatic system. Case Report: We report the case of a patient with coagulopathy of unclear etiology undergoing a stereotactic brainstem biopsy. Conclusion: A medication scheme with tranexamic acid and desmopressin effectively decreased the patient's bleeding time in vivo and the procedure was carried out without complications. [ABSTRACT FROM AUTHOR]