Debulking From Within: A Robotic Steerable Cannula for Intracerebral Hemorrhage Evacuation
Debulking From Within: A Robotic Steerable Cannula for Intracerebral Hemorrhage Evacuation
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DOI：
10.1109/tbme.2013.2260860
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发表时间：
2013-09-01
影响因子：
4.6
通讯作者：
Webster, Robert J., III
中科院分区：
文献类型：
--
作者：
Burgner, Jessica;Swaney, Philip J.;Webster, Robert J., III
脑出血的高发病率和40%的死亡率促使人们采取新的治疗方法。有时会尝试手术来修复大脑，尽管无论是否进行手术，患者的结局都是相似的。我们假设，手术减压并不是更有效，因为目前的开放手术技术破坏了健康的脑组织，以接近出血形成的凝块，抵消了手术的好处。为了解决这个问题，我们提出了一种微创的针为基础的方法，其中使用超弹性，膨胀的抽吸套管，从针部署的凝块是从内缩小。该抽吸套管的尖端通过套管和针的协调插入和缩回以及套管的轴向旋转来控制。我们描述了一个可灭菌和生物相容性的机器人，可以控制三个自由度的针和套管的设计。图像引导是通过采用最初为脑活检开发的方法来实现的。我们提供了一种优化方法，用于选择一个或多个顺序使用的抽吸套管的特性，以最大限度地减少出血，基于术前医学图像数据。体外实验表明，根据所用的插管数量和展开方法，可排出83-92%的出血量。
New approaches to intracerebral hemorrhage management are motivated by its high incidence and 40% mortality rate. Surgery is sometimes attempted to decompress the brain, although patient outcomes are similar regardless of whether surgery occurs. We hypothesize that surgical decompression is not more effective because current open surgical techniques disrupt healthy brain tissue to access the clot formed by the hemorrhage, offsetting the benefits of surgery. To address this, we propose a less invasive needle-based approach in which the clot is debulked from within using a superelastic, precurved aspiration cannula that is deployed from a needle. The tip of this aspiration cannula is controlled by coordinated insertion and retraction of the cannula and needle, as well as axial rotation of the cannula. We describe the design of a sterilizable and biocompatible robot that can control the three degrees of freedom of the needle and cannula. Image guidance is achieved by adapting an approach originally developed for brain biopsy. We provide an optimization method for the selection of the precurvatures of one or more sequentially used aspiration cannulas to maximize hemorrhage evacuation, based on preoperative medical image data. In vitro experiments demonstrate the feasibility of evacuating 83-92% of hemorrhage volume, depending on the number of tubes and deployment method used.