Neurosurgical Intracerebral Hemorrhage Evacuation (NICHE) Robot

神经外科脑出血清除（NICHE）机器人

• 批准号: 9327628
• 负责人: JAYDEV P. DESAI
• 金额: $ 10.11万
• 依托单位: GEORGIA INSTITUTE OF TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9327628
• 关键词: Neurosurgical; Intracerebral; Hemorrhage; Evacuation; NICHE

Project Summary Spontaneous supratentorial intracerebral hemorrhage (ICH) occurs in ≈2 million people worldwide every year and represents a major global public-health problem. ICH is associated with a 30-day mortality rate of 32–50%, and 6 month functional independence is achieved in only 20–25% of individuals who survive such hemorrhages. It is widely accepted that removal of the blood clot should be an important goal of early management of patients with ICH, but despite theoretical benefits, classic craniotomy for ICH removal remains controversial, because clear evidence of efficacy is lacking. Minimally invasive surgery (MIS) causes minimal trauma to brain tissues and significantly improves the number of functionally independent patients at 90 days. However, this apparent benefit is largely negated by high rates of rebleeding. Current technologies to remove ICH have serious limitations. All currently available methods of MIS for ICH evacuation employ line-of-sight, rigid tubes. Because of this, they generally rely on enzymatic thrombolytic agents [e.g., urokinase or tissue plasminogen activator (rtPA)] introduced into the clot to liquefy it, prior to irrigating it out. There are two important limitations with enzymatic thrombolysis. First, it is very slow, requiring multiple injections of thrombolytic agents and more than 24 hours to reduce ICH volume. Therefore, the potential benefit of rapidly reducing intracranial pressure, which can be lifesaving, is completely lost. In addition, enzymatic thrombolysis can be dangerous, since there is no control over where the thrombolytic agent diffuses and thus re-hemorrhage rates are unacceptably high. There is a clear and urgent need to develop an alternative technology for evacuation of ICH without increasing the risk of rebleeding. We envision a Neurosurgical Intracerebral Hemorrhage Evacuation (NICHE) robot for ICH removal that will be: a) compatible with the imaging modality, b) 6 mm in diameter and about 20 cm long to allow deployment into a deep ICH in the basal ganglia or thalamus via non-eloquent frontal lobe cortex rostral to the coronal suture, c) discretely actuated with multiple degrees-of-freedom (DOFs) and the tip link of the robot having the capability to bend into a “J-shape” to allow ICH removal outside of the line-of-sight trajectory and additional joints to allow positioning the tip link within the ICH, d) equipped with suction and irrigation lines running through its hollow core and have bipolar electrocautery probes to liquefy the ICH, and e) under the immediate and direct guidance of the neurosurgeon at all times. To realize the NICHE robot, we will address three specific aims: 1) Design and develop a multi-joint discretely actuated and steerable NICHE robot with bipolar electrocautery probes and a suction and irrigation channel for electrocauterizing the ICH, 2) Develop an intra-operative imaging algorithm for precise, real-time tracking of robotic cannula and to monitor the progress of ICH evacuation using low radiation dose cone-beam CT, and 3) Demonstrate the safety and efficacy of NICHE robot in clinically relevant models of ICH.

项目摘要 自发性幕上脑出血（ICH）发生在全世界约1200万人中 这是一个重大的全球公共卫生问题。ICH与30天的 死亡率为32 - 50%，仅20 - 25%的患者实现了6个月的功能独立。 在这样的灾难中幸存下来的人。人们普遍认为，清除血块应该 是ICH患者早期管理的一个重要目标，但尽管有理论上的好处， 开颅术清除颅内出血仍有争议，因为缺乏明确的疗效证据。微创 侵入性手术（MIS）对脑组织造成的创伤最小， 90天后功能独立的患者。然而，这种明显的好处在很大程度上被高 再出血率。目前用于去除ICH的技术具有严重的局限性。所有当前可用 用于ICH疏散的MIS方法采用视线刚性管。因此，他们通常依赖 酶促血栓溶解剂[例如，尿激酶或组织纤溶酶原激活剂（rtPA）]引入到 在将其冲洗出来之前，酶促反应有两个重要的限制， 血栓溶解首先，它是非常缓慢的，需要多次注射溶栓剂和超过24 小时以减少ICH体积。因此，快速降低颅内压的潜在益处， 可以拯救生命的东西完全消失了此外，酶促血栓溶解可能很危险，因为没有 对血栓溶解剂扩散位置的控制以及由此导致的再出血率是不可接受的高。 显然迫切需要开发一种非物质文化遗产的替代技术 而不会增加再出血的风险。我们设想一个神经外科脑出血 用于ICH清除的疏散（NICHE）机器人，将：a）与成像模式兼容，B）6 直径约20 mm，长约20 cm，可部署到基底神经节或丘脑的深部ICH中 通过冠状缝喙侧的非功能性额叶皮质，c）用多个离散驱动 自由度（DOF）和具有弯曲成"J形"的能力的机器人的末端连杆， 允许在视线轨迹外取出ICH，并允许定位头端连接件的额外接头 在ICH内，d）配备有贯穿其中空芯的抽吸和冲洗管路，并且具有 双极电烙术探头，用于治疗ICH，以及e）在医生的直接指导下， 神经外科医生为了实现NICHE机器人，我们将解决三个具体目标：1）设计和 开发了一种多关节离散驱动和可操纵的NICHE机器人，该机器人具有双极电烙探针 以及用于电灼ICH的抽吸和冲洗通道，2）开发术中 用于精确、实时跟踪机器人插管和监测ICH进展的成像算法 使用低辐射剂量锥形束CT进行疏散，以及3）证明NICHE的安全性和有效性 ICH临床相关模型中的机器人。

项目成果

Development of a Meso-Scale SMA-Based Torsion Actuator for Image-Guided Procedures.

• DOI: 10.1109/tro.2016.2623348
• 发表时间: 2017-02
• 期刊: IEEE transactions on robotics : a publication of the IEEE Robotics and Automation Society
• 作者: Sheng J;Gandhi D;Gullapalli R;Simard JM;Desai JP
• 通讯作者: Desai JP

Development of a Meso-Scale Fiberoptic Rotation Sensor for a Torsion Actuator.

• DOI: 10.1109/lra.2017.2773671
• 发表时间: 2018-01
• 期刊: IEEE robotics and automation letters
• 影响因子: 5.2
• 作者: Sheng J;Desai JP
• 通讯作者: Desai JP