Optimization of Curvilinear Needle Trajectories for Transforamenal Hippocampotomy.
Optimization of Curvilinear Needle Trajectories for Transforamenal Hippocampotomy.
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DOI：
10.1227/neu.0000000000001361
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发表时间：
2017-02
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影响因子：
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通讯作者：
Barth EJ
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文献类型：
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作者：
Comber DB;Pitt EB;Gilbert HB;Powelson MW;Matijevich E;Neimat JS;Webster RJ 3rd;Barth EJ
背景：最近开发的磁共振成像引导激光诱导热疗法为用于肿瘤切除或杏仁核海马切除术的开颅手术提供了一种微创替代方案，以控制癫痫病。目前的激光诱导热疗法依赖于线性立体定向轨迹，该轨迹要求麻花钻进入颅骨，并且可能需要较长时间穿过健康的大脑。使用机器人驱动的伸缩式弯曲针有可能通过根据消融结构的弯曲形状定制轨迹并通过自然孔口进入来减少手术侵入性。 目的：探讨使用同心管机器人通过卵圆孔进入海马进行热疗的可行性，从而提供一种无需颅骨钻孔的经皮治疗癫痫的方法。 方法：从 10 名患者的双计算机断层扫描/磁共振图像体积中分割出头骨和双侧海马体。对于 20 个海马体中的每一个，都设计并优化了一个同心管机器人，以沿着从卵圆孔到并从头到尾穿过海马体的轨迹。 结果：在所有 20 个病例中，最佳情况、平均情况和最坏情况下海马中轴与针骨干之间的平均距离（误差）分别为 0.55、1.11 和 1.66 毫米。 结论：这些曲线轨迹可以将消融探针准确地经椎间孔递送至典型的海马体积。该策略有可能减少手术的侵入性并提高海马消融的完整性。
BACKGROUND: The recently developed magnetic resonance imaging–guided laser-induced thermal therapy offers a minimally invasive alternative to craniotomies performed for tumor resection or for amygdalohippocampectomy to control seizure disorders. Current laser-induced thermal therapies rely on linear stereotactic trajectories that mandate twist-drill entry into the skull and potentially long approaches traversing healthy brain. The use of robotically driven, telescoping, curved needles has the potential to reduce procedure invasiveness by tailoring trajectories to the curved shape of the ablated structure and by enabling access through natural orifices. OBJECTIVE: To investigate the feasibility of using a concentric tube robot to access the hippocampus through the foramen ovale to deliver thermal therapy and thereby provide a percutaneous treatment for epilepsy without drilling the skull. METHODS: The skull and both hippocampi were segmented from dual computed tomography/magnetic resonance image volumes for 10 patients. For each of the 20 hippocampi, a concentric tube robot was designed and optimized to traverse a trajectory from the foramen ovale to and through the hippocampus from head to tail. RESULTS: Across all 20 cases, the mean distances (errors) between the hippocampus medial axis and backbone of the needle were 0.55, 1.11, and 1.66 mm for the best, mean, and worst case, respectively. CONCLUSION: These curvilinear trajectories would provide accurate transforamenal delivery of an ablation probe to typical hippocampus volumes. This strategy has the potential both to decrease the invasiveness of the procedure and to increase the completeness of hippocampal ablation.