Improving the Safety and Efficacy of Intraventricular Neurosurgery via Robotics

项目摘要 在美国每年进行的超过380，000例脑部手术中，至少有20%是切除位于 在脑室内部或邻近脑室，即，充满透明液体的空腔。使用内窥镜，神经外科医生 可以通过脑室导航他们的仪器到达这些病变，对健康大脑的损伤较小 比在开放手术中发生的组织。然而，目前的内窥镜受到三个主要因素的限制， 将它们的使用限制在大约5%的潜在病例（所有脑手术的1%）。首先，内窥镜有工具 平行于工作轴出现，排除了开放手术的许多双手手术技术 用来解剖组织和止血其次，大多数神经外科医生使用直的刚性内窥镜 无法在不造成严重脑牵拉损伤的情况下通过拐角。第三，有风险 留下显著的残留肿瘤，也损伤了关键的神经血管结构， 在视线范围内前两个问题可以通过在内窥镜尖端提供两个灵巧臂来解决 并且通过实现用于在拐角周围导航的容易控制的可操纵性。第三个问题可以解决 通过术中MR成像，在整个手术过程中对靶病变进行实时成像的额外受益 操作然而，目前，术中MRI仅限于开放手术，并且仅允许间歇性成像 由于标准手术器械的MR不兼容性以及内部操作的人体工程学困难， 扫描仪该项目的目标是创建用于MR扫描仪内部的机器人内窥镜。这些外科医生- 受控器械将能够直观地操纵通过心室到达损伤部位。两个小费 在内窥镜和MR联合检查下，可展开固定的双指臂进行双手病变切除 视觉化预计这些系统将能够在内窥镜下切除50%的内部病变， 邻近脑室（占所有颅内病变的10%），同时还提高了当前治疗的安全性和有效性。 内窥镜手术-导致可以治疗的脑部手术数量增加10倍 内窥镜检查。目的我将创建一个直MRI兼容双手神经内窥镜与两个灵巧的手臂 包括伸缩弹性管。Aim II将提供更长的曲线手术轨迹， 通过整合内窥镜伸缩肌腱驱动技术治疗脑室和脑室周围病变 与Aim 1的尖端安装臂的可操控性。这两个系统将通过一系列的评估和完善， 体模和动物研究。项目负责人是神经内窥镜手术的专家，MRI兼容 技术和医疗机器人设计。

Project Summary Out of over 380,000 brain surgeries performed in the USA every year, at least 20% are to remove lesions located inside or adjacent to the brain’s ventricles, i.e., cavities filled with clear fluid. Using endoscopes, neurosurgeons can navigate their instruments through the ventricles to reach these lesions with less damage to healthy brain tissue than occurs in open surgery. Current endoscopes, however, are restricted by three main factors which limit their use to about 5% of the potential cases (1% of all brain surgeries). First, endoscopes have tools emerging parallel to the working shaft, precluding many of the two-handed surgical techniques of open surgery that are used to dissect tissue and stop bleeding. Second, most neurosurgeons use straight rigid endoscopes that cannot negotiate around corners without causing significant brain retraction injury. Third, there is a risk of leaving behind significant residual tumors and also injuring critical neurovascular structures that are not directly in the line of sight. The first two problems can be solved by providing two dexterous arms at the tip of endoscope and by enabling easily controllable steerability for navigating around corners. The third issue can be addressed by intraoperative MR imaging, with the added benefit of real-time imaging of the target lesion throughout the operation. Currently, however, intraoperative MRI is limited to open surgery and allows only intermittent imaging due to MR-incompatibility of standard surgical instruments as well as the difficult ergonomics of operating inside a scanner. The project goal is to create robotic endoscopes for use inside an MR scanner. These surgeon- controlled instruments will enable intuitive steering through the ventricles to the site of a lesion. There, two tip- mounted dextrous arms can be deployed for bimanual lesion resection under combined endoscopic and MR visualization. It is anticipated that these systems will enable endoscopic resection of 50% of lesions inside and adjacent to the ventricles (10% of all intracranial lesions) while also improving the safety and efficacy of current endoscopic procedures – resulting in a 10-fold increase in the number of brain surgeries that can be treated endoscopically. Aim I will create a straight MRI-compatible bimanual neuroendoscope with two dexterous arms comprised of telescoping elastic tubes. Aim II will offer a longer curvilinear surgical trajectory to deeper ventricular and periventricular lesions by integrating a telescoping tendon-drive technology for endoscope steerability with the tip-mounted arms of Aim 1. Both systems will be evaluated and refined through a series of phantom and animal studies. The project leaders are experts in neuroendoscopic surgery, MRI-compatible technologies and medical robot design.