Curing Epilepsy with a Needle

 描述(由申请人提供)：该项目的目标是开发和评估一种核磁共振引导的机器人系统，以实现新颖的经孔切除海马体来治疗癫痫。这项工作的动机是癫痫的高患病率和严重残疾。全球癫痫的患病率为每100到200人中就有1人，20-40%的患者对药物治疗没有反应，并面临癫痫原因不明猝死(SUDEP)的风险，估计比率高达每名患者每年1%[1-5]。虽然众所周知，海马体切除术可以以很高的比率(70%-80%)永久治愈癫痫，但由于这种开放式脑部手术的侵袭性和发病率[4，6-7]，这种手术的利用率极低。我们的新可导向针系统将通过一个直的外插管提供经皮治疗，该外插管被手动插入脸颊皮肤下方，并对接到卵圆孔，这是颅底的一个自然小开口。一个螺旋弯曲的形状记忆合金针，在其远端由精密的气动机器人驱动，将操纵射频消融电极从卵圆孔到海马体，并从头到尾。磁共振成像和体温测量将引导针沿计划的路径，并监测热消融治疗的输送。该项目的目标包括：1)修改和评估现有的机器人和可定向消融电极硬件，2)开发用于消融电极附近组织的可视化和温度测量的磁共振成像协议，3)在完全MRI指导下的体外模型中使用模拟程序，并通过确证的组织学，展示该系统在针形消融和适形消融中的有效性。一个由多学科调查人员组成的小组将进行 这些目标结合了癫痫外科(Co-I Neimat)、机器人系统的机械设计和精确控制(Pi Barth)、同心管可控针的设计和控制(Pi Webster)以及用于引导干预和热疗的核磁共振和测温(Co-I Grissom)的专业知识。这个R21项目的终点和成功的衡量标准将是演示在模拟程序中使用MR引导通过卵圆孔进行受控和精确的机器人消融。这项工作将为未来R01资助的涉及身体和动物研究的项目铺平道路。

 DESCRIPTION (provided by applicant): The objective of this project is to develop and evaluate an MRI-guided robotic system to enable novel, transforamenal ablation of the hippocampus to treat epilepsy. This work is motivated by the high prevalence of and severe disability caused by epilepsy. Epilepsy has a prevalence of 1 in 100 to 200 persons globally, with 20-40% of the patient population being unresponsive to drug therapy and at risk for sudden unexplained death in epilepsy (SUDEP) at rates estimated to be as high as 1% per patient per year [1-5]. While hippocampectomy is known to permanently cure epilepsy at a high rate (70-80%), this surgery is vastly underutilized, due to the invasiveness and perceived morbidity of this open brain procedure [4,6-7]. Our new steerable needle system will provide a percutaneous treatment by deploying through a straight outer cannula, which is manually inserted beneath the cheek skin and docked to the foramen ovale, a small natural opening in the skull base. A helically-curved, shape-memory alloy needle, actuated at its distal end by a precision pneumatic robot, will maneuver a radiofrequency ablation electrode from the foramen ovale to and through the hippocampus from head to tail. Magnetic resonance imaging and thermometry will guide the needle along the planned path, and monitor the delivery of thermal ablative therapy. The aims of this project involve: 1) modifying and evaluating existing robot and steerable ablation electrode hardware, 2) developing MR imaging protocols for visualization and temperature measurement of tissue adjacent to the ablation electrode, and 3) demonstrating the system's effectiveness in needle steering and conformal ablations, using mock procedures in ex-vivo phantoms under full MRI guidance, with confirmatory histology. A multidisciplinary team of investigators will carry out these aims by combining expertise in epilepsy surgery (Co-I Neimat), mechanical design and precision control of robotic systems (PI Barth), design and control of concentric tube steerable needles (PI Webster), and MRI and thermometry for guided interventions and thermotherapy (Co-I Grissom). The endpoint and metric of success for this R21 project will be the demonstration of a controlled and precise robot-enabled ablation through the foramen ovale in a mock procedure using MR guidance. This work will pave the way for a future R01-funded project involving cadaveric and animal studies.