Curing Epilepsy with a Needle

 描述（由申请人提供）：本项目的目的是开发和评价MRI引导的机器人系统，以实现新型经椎间孔海马消融术治疗癫痫。这项工作的动机是癫痫的高患病率和严重残疾造成的。全球癫痫的患病率为1/100至200人，20-40%的患者人群对药物治疗无反应，并有癫痫不明原因猝死（SUDEP）的风险，估计每年每例患者的发生率高达1%[1-5]。虽然已知小脑切除术可永久性治愈癫痫，治愈率很高（70-80%），但由于这种开放性脑手术的侵入性和可感知的发病率，这种手术的利用率极低[4，6 -7]。我们的新型可操纵针系统将通过直外套管展开提供经皮治疗，该外套管手动插入脸颊皮肤下方并对接到卵圆孔（颅底的一个小的自然开口）。一个螺旋弯曲的形状记忆合金针，在其远端由一个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穿过海马体。磁共振成像和温度测量将引导针沿着计划的路径，并监测热消融治疗的输送。本项目的目的包括：1）修改和评价现有的机器人和可操纵消融电极硬件，2）开发MR成像方案，用于消融电极附近组织的可视化和温度测量，以及3）在完整MRI引导下使用体外体模中的模拟手术，使用确认的组织学，证明系统在针操纵和适形消融中的有效性。一个多学科的调查小组将进行 通过结合癫痫手术（Co-I Neimat）、机器人系统的机械设计和精确控制（PI Barth）、同心管可操纵针的设计和控制（PI韦伯斯特）以及用于引导介入和热疗的MRI和测温（Co-I Grissom）的专业知识，该R21项目的终点和成功指标将是使用MR引导在模拟手术中通过卵圆孔进行受控和精确的机器人启用消融。这项工作将为未来R 01资助的涉及尸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.