Robotic "Threading the Needle" Resolves Patient's Blindness Threat

Background

A 69-year-old patient known as Mr. Liu developed sudden symptoms in his right eye including pain, conjunctival congestion with blood vessels, diplopia (double vision), and restricted eye movement. He was diagnosed with a cavernous sinus dural arteriovenous fistula (dAVF), an abnormal arteriovenous shunt in the dura near the cavernous sinus that can lead to increased venous pressure in the orbit. Untreated, it risks vision loss or intracranial hemorrhage. Mr. Liu initially underwent interventional embolization at a local hospital, but it failed due to the lesion's difficult location. He was then referred to the neurosurgery department of the General Hospital of Northern Theater Command seeking a solution to the threat of blindness.

Reports from October 2025, based on information released on October 13, detailed how the case presented significant treatment challenges given the anatomy involved.

What was achieved

The team led by Director Liang Guobiao innovatively adopted robot-assisted transorbital venous puncture embolization for this complex case. Working with Director Physician Tao Yingqun's team for robotic path planning and Zhu Tingzhun's team for the embolization, they conducted preoperative discussions, multiple simulations, and formulated a detailed surgical plan. The procedure was completed successfully on the day of surgery.

Postoperative angiography showed the fistula was completely occluded, with normal restoration of intracranial blood flow and no injury to ocular structures. Mr. Liu's eye pain disappeared quickly, eye movement and vision improved significantly. The puncture site had almost no visible trace. He was discharged smoothly after three days. Mr. Liu thanked the team and the 'robot doctor' for preserving his right eye. The team had earlier pioneered transnasal neuroendoscopic combined with interventional embolization for similar complex dAVF cases.

How it works

Dural arteriovenous fistulas create direct high-pressure arterial flow into low-pressure venous systems, here affecting the cavernous sinus and ophthalmic veins, causing the observed eye symptoms. Treatment requires blocking the fistulous connection, typically by delivering embolic agents like coils via a microcatheter placed in the draining vein.

Conventional access to the ophthalmic vein for embolization can involve open orbital exposure or guided puncture using ultrasound or DSA. These methods can involve significant trauma, puncture inaccuracy, and lower success rates, with risks including vision impairment.

In this approach, the surgical robot was used to design an optimal safe puncture path that perfectly avoided important nerves, blood vessels, and the eyeball structure to reach the target vessel. It specified the precise puncture point, angle, and depth based on imaging. Under digital subtraction angiography (DSA) guidance, the team performed the transorbital puncture exactly per the robotic plan, advanced the microcatheter through the needle to the fistula, and deployed coils for full embolization. This turned high-risk experiential puncture into a rehearsable, plannable, and precise intervention.

What it means for international patients

This case demonstrates that major hospitals in China are applying robotic technology to address complex neurointerventional challenges in cerebrovascular diseases such as dural arteriovenous fistulas. Such techniques may offer minimally invasive options with enhanced precision for patients with difficult-to-access lesions where traditional methods have limitations or failed.

International patients considering care for similar conditions should contact the General Hospital of Northern Theater Command directly to determine eligibility for robotic-assisted procedures, current availability, and any arrangements for overseas visitors. Specific support services and individual suitability must be confirmed with the hospital as no dedicated international medical tourism program details were reported in available sources.

About the hospital

The General Hospital of Northern Theater Command is located in Shenyang, Liaoning Province, with campuses including Shenhe, Heping, and Beiling districts. It is a large comprehensive tertiary Grade A (Class 3A) hospital affiliated with the People's Liberation Army Northern Theater Command. It was formally established in 2018 through the merger of the former Shenyang Military Region General Hospital (with origins in 1948) and the PLA 202nd Hospital.

The hospital integrates medical care, teaching, research, and healthcare. It features a PLA Institute of Neuromedicine associated with its neurosurgery department and is recognized for cardiovascular specialties that have ranked first in Northeast China per Fudan University hospital reputation lists. It employs advanced equipment including surgical robots for neurosurgical applications and serves as a training base for several medical universities. It has a track record of innovation in neurovascular interventions.