Improving the Safety and Efficacy of Intraventricular Neurosurgery via Robotics

项目摘要 在美国每年进行的超过38万例脑外科手术中，至少有20%是为了切除位于 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 可以引导他们的仪器通过脑室到达这些病变，而对健康大脑的损害更小 组织比在开放手术中出现的更多。然而，目前的内窥镜检查受到三个主要因素的限制 将它们的使用限制在潜在病例的5%左右(所有脑外科手术的1%)。首先，内窥镜有工具 与工作轴平行出现，排除了许多开放手术的双手手术技术 用来解剖组织和止血。其次，大多数神经外科医生使用直立的硬质内窥镜 这不可能在不造成严重脑部退缩损伤的情况下绕过弯道。第三，存在以下风险 留下显著的残留肿瘤，并损伤不直接的关键神经血管结构 在视线范围内。前两个问题可以通过在内窥镜顶端提供两个灵巧的手臂来解决 并且通过实现在拐角处导航的容易控制的可控性。第三个问题是可以解决的 通过术中磁共振成像，增加了在整个手术过程中对目标病变进行实时成像的好处 手术。然而，目前，术中核磁共振仅限于开放手术，并且仅允许间歇性成像 由于标准手术器械的磁共振不兼容，以及内部操作的困难的人体工程学 一台扫描仪。该项目的目标是制造用于磁共振扫描仪内部的机器人内窥镜。这些外科医生- 受控仪器将能够直观地引导脑室到达病变部位。好了，两点建议- 在内窥镜和磁共振的联合下，可以部署安装的灵巧手臂进行双臂病变切除 视觉化。预计这些系统将能够在内窥镜下切除50%的内部和 脑室旁(占所有颅内病变的10%)，同时也提高了电流的安全性和有效性 内窥镜手术--可治疗的脑外科手术数量增加了10倍 内窥镜检查。目的研制一种具有两只灵巧手臂、与磁共振成像兼容的直立双指甲神经内窥镜。 由可伸缩的弹性管组成。AIM II将提供更长的曲线手术轨迹到更深 集成伸缩式肌腱驱动技术的内窥镜脑室和脑室周围病变 使用AIM 1的尖端安装臂的操纵性。这两个系统将通过一系列 幻影和动物研究。项目负责人是神经内窥镜手术、核磁共振兼容方面的专家 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.