Robotic system for MRI-guided stereotactic neurosurgery.
Robotic system for MRI-guided stereotactic neurosurgery.
复制标题
MRI引导的立体定向神经外科手术系统。
DOI：
10.1109/tbme.2014.2367233
复制
发表时间：
2015-04
期刊：
影响因子：
--
通讯作者：
Fischer GS
中科院分区：
文献类型：
--
作者：
Li G;Su H;Cole GA;Shang W;Harrington K;Camilo A;Pilitsis JG;Fischer GS
立体定向术是一种神经外科技术，通常利用机械框架并通过术前成像引导，可能需要数小时才能到达特定目标。许多步骤中的任何一个错误或目标解剖结构与术前计划的偏差，如脑移位（高达20 mm），可能会影响靶向准确性，从而影响治疗有效性。此外，由于该手术通常通过颅骨中的小钻孔开口进行，该小钻孔开口阻止组织可视化，因此介入对于操作者来说基本上是“盲的”，具有有限的术中确认手段，这可能导致准确性和安全性降低。本系统预期用于满足增强脑深部电刺激（DBS）电极导线置入的图像引导立体定向神经外科手术的效率、准确性和安全性的临床需求。这项工作描述了一种用于脑深部电刺激手术的磁共振成像（MRI）引导的机器人驱动立体定向神经干预系统，该系统具有缩短手术时间的潜力，同时提高了靶向准确性并增强了安全性。这是通过仪器的同时机器人操作和交互式更新的原位MRI引导来实现的，该原位MRI引导能够实现解剖结构和介入仪器的可视化。在同时驱动和成像过程中，该系统已证明信噪比（SNR）变化小于15%，几何失真伪影小于0.20%，而不影响成像可用性，以可视化和引导手术。光学跟踪和MRI体模实验简化了原型系统的临床工作流程，证实了靶向精度，头端位置的3轴均方根误差为1.38 ± 0.45 mm，插入角度为2.03 ± 0.58°。
Stereotaxy is a neurosurgical technique that can take several hours to reach a specific target, typically utilizing a mechanical frame and guided by preoperative imaging. An error in any one of the numerous steps or deviations of the target anatomy from the preoperative plan such as brain shift (up to 20 mm), may affect the targeting accuracy and thus the treatment effectiveness. Moreover, because the procedure is typically performed through a small burr hole opening in the skull that prevents tissue visualization, the intervention is basically “blind” for the operator with limited means of intraoperative confirmation that may result in reduced accuracy and safety. The presented system is intended to address the clinical needs for enhanced efficiency, accuracy, and safety of image-guided stereotactic neurosurgery for Deep Brain Stimulation (DBS) lead placement. The work describes a magnetic resonance imaging (MRI)-guided, robotically actuated stereotactic neural intervention system for deep brain stimulation procedure, which offers the potential of reducing procedure duration while improving targeting accuracy and enhancing safety. This is achieved through simultaneous robotic manipulation of the instrument and interactively updated in situ MRI guidance that enables visualization of the anatomy and interventional instrument. During simultaneous actuation and imaging, the system has demonstrated less than 15% signal-to-noise ratio (SNR) variation and less than 0.20% geometric distortion artifact without affecting the imaging usability to visualize and guide the procedure. Optical tracking and MRI phantom experiments streamline the clinical workflow of the prototype system, corroborating targeting accuracy with 3-axis root mean square error 1.38 ± 0.45 mm in tip position and 2.03 ± 0.58° in insertion angle.