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 自发性上流脑内出血（ICH）发生在全球约200万人 每年，代表了一个主要的全球公共卫生问题。 ICH与30天有关 仅20-25％的死亡率为32–50％和6个月的功能独立性 生存这样的出血的人。人们普遍认为，去除血块应该 成为早期管理ICH患者的重要目标，但渴望理论上的好处，经典 由于缺乏明确的效率证据，因此要去除ICH的开裂切开术仍然存在争议。最少 侵入性手术（MIS）导致最小的创伤对脑组织，并显着改善了 在90天内功能独立的患者。但是，这种明显的好处在很大程度上被高 再出血的速度。当前去除ICH的技术有严重的局限性。所有当前可用 ICH撤离员工视线，刚性管的MIS方法。因此，他们通常依靠 在酶促溶栓剂[ 在灌溉之前将其液化的凝块。酶促有两个重要的局限性 溶栓。首先，它非常慢，需要多次注射溶栓剂，超过24 减少ICH数量的小时。因此，快速降低颅内压的潜在益处， 可以挽救生命，完全丢失。另外，酶溶栓分解可能很危险，因为没有 控制溶栓剂扩散的位置，因此重新发射率不可接受。 明确而迫切需要开发一种撤离ICH的替代技术 而不会增加再出血的风险。我们设想神经外科脑内出血 撤离（利基）机器人用于ICH去除的机器人：a）与成像方式兼容，b）6 直径毫米，长约20厘米长，可以在基底神经节或丘脑中部署到深处。 通过非俗气的额叶皮层延伸到冠状缝合线，c）离散地被多个激活 自由度（DOFS）和机器人的尖端链接具有弯曲为“ J形”的能力 允许ICH卸下视线轨迹和其他关节以允许定位尖端链接 在ICH中，D）配备了惊喜和灌溉线，穿过其空心核心并具有 双极电极问题以液化为ICH，E）在直接和直接的指导下 神经外科医生始终。要实现利基机器人，我们将解决三个具体目标：1）设计和 开发具有双极电动问题的多接离散激活和可传输的利基机器人 以及用于电动性ICH的任务和灌溉渠道，2）发展术中 成像算法，用于精确，机器人套管实时跟踪并监视ICH的进度 使用低辐射剂量锥束CT撤离，3）证明了利基市场的安全性和效率 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