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 自发性幕上脑出血发生在全球200万≈人群中 并代表着一个重大的全球公共卫生问题。ICH与30天的 死亡率32-50%，6个月功能独立仅有20%-25% 在这样的出血中幸存下来的人。人们普遍认为，清除血栓应该 是脑出血患者早期治疗的重要目标，但尽管理论上有好处，经典的 开颅手术切除脑出血仍然存在争议，因为缺乏明确的有效性证据。最低限度 侵入性手术(MIS)对脑组织造成的创伤很小，并显著增加了 90天后功能独立的患者。然而，这一明显的好处在很大程度上被高 再出血率。目前消除脑出血的技术有严重的局限性。目前全部可用 脑出血后送管理信息系统的方法采用视线、刚性管。正因为如此，他们通常依赖于 关于引入的酶溶栓剂[如尿激酶或组织型纤溶酶原激活剂(RtPA)] 在冲洗它之前，用凝块来液化它。酶制剂有两个重要的局限性 溶栓治疗。首先，它非常缓慢，需要多次注射溶栓剂和超过24 几个小时，以减少ICH的量。因此，快速降低颅内压的潜在好处是 可以救人的，是完全失落的。此外，酶溶栓可能是危险的，因为没有 控制溶栓剂在哪里扩散，因此再出血率高得令人无法接受。 显然，迫切需要开发一种替代技术来疏散非物质文化遗产 而不会增加再次出血的风险。我们预见一场神经外科脑出血 用于清除非物质文化遗产的疏散(利基)机器人将：a)与成像方式兼容，b)6 直径约20厘米，可部署到基底节或丘脑的深部脑出血 通过非雄辩的额叶皮质吻部至冠状缝合，c)离散地由多个 自由度(DOF)和机器人的尖端连杆，能够弯曲成“J”形以 允许在视线轨迹和附加关节之外移除ICH，以允许定位尖端链接 在非物质文化遗产内，d)配备了通过其中空核心的吸入和灌溉管道，并具有 双极电灼探头液化脑出血，和e)在直接和直接的指导下 一直都是神经外科医生。为了实现小众机器人，我们将解决三个具体目标：1)设计和 双极电灼探头多关节离散驱动可操纵壁龛机器人的研制 和用于电灼烧脑出血的抽吸和冲洗通道，2)发展术中 用于精确、实时跟踪机器人插管和监测脑出血进展的成像算法 使用低辐射剂量锥束CT进行疏散，以及3)证明了壁龛的安全性和有效性 临床相关脑出血模型中的机器人。

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