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Mayer R, Desai K, Aguiar RSDT, McClure JJ, Kato N, Kalman C, Pilitsis JG. Evolution of Deep Brain Stimulation Techniques for Complication Mitigation. Oper Neurosurg (Hagerstown) 2024; 27:148-157. [PMID: 38315020 DOI: 10.1227/ons.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024] Open
Abstract
Complication mitigation in deep brain stimulation has been a topic matter of much discussion in the literature. In this article, we examine how neurosurgeons as individuals and as a field generated and adapted techniques to prevent infection, lead fracture/lead migration, and suboptimal outcomes in both the acute period and longitudinally. The authors performed a MEDLINE search inclusive of articles from 1987 to June 2023 including human studies written in English. Using the Rayyan platform, two reviewers (J.P. and R.M.) performed a title screen. Of the 776 articles, 252 were selected by title screen and 172 from abstract review for full-text evaluation. Ultimately, 124 publications were evaluated. We describe the initial complications and inefficiencies at the advent of deep brain stimulation and detail changes instituted by surgeons that reduced them. Furthermore, we discuss the trend in both undesired short-term and long-term outcomes with emphasis on how surgeons recognized and modified their practice to provide safer and better procedures. This scoping review adds to the literature as a guide to both new neurosurgeons and seasoned neurosurgeons alike to understand better what innovations have been trialed over time as we embark on novel targets and neuromodulatory technologies.
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Affiliation(s)
- Ryan Mayer
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
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Huang Z, Meng L, Bi X, Xie Z, Liang W, Huang J. Efficacy and safety of robot-assisted deep brain stimulation for Parkinson's disease: a meta-analysis. Front Aging Neurosci 2024; 16:1419152. [PMID: 38882524 PMCID: PMC11176545 DOI: 10.3389/fnagi.2024.1419152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
Objective This meta-analysis aims to assess the effectiveness and safety of robot-assisted deep brain stimulation (DBS) surgery for Parkinson's disease(PD). Methods Four databases (Medline, Embase, Web of Science and CENTRAL) were searched from establishment of database to 23 March 2024, for articles studying robot-assisted DBS in patients diagnosed with PD. Meta-analyses of vector error, complication rate, levodopa-equivalent daily dose (LEDD), Unified Parkinson's Disease Rating Scale (UPDRS), UPDRS II, UPDRS III, and UPDRS IV were performed. Results A total of 15 studies were included in this meta-analysis, comprising 732 patients with PD who received robot-assisted DBS. The pooled results revealed that the vector error was measured at 1.09 mm (95% CI: 0.87 to 1.30) in patients with Parkinson's disease who received robot-assisted DBS. The complication rate was 0.12 (95% CI, 0.03 to 0.24). The reduction in LEDD was 422.31 mg (95% CI: 68.69 to 775.94). The improvement in UPDRS, UPDRS III, and UPDRS IV was 27.36 (95% CI: 8.57 to 46.15), 14.09 (95% CI: 4.67 to 23.52), and 3.54 (95% CI: -2.35 to 9.43), respectively. Conclusion Robot-assisted DBS is a reliable and safe approach for treating PD. Robot-assisted DBS provides enhanced accuracy in contrast to conventional frame-based stereotactic techniques. Nevertheless, further investigation is necessary to validate the advantages of robot-assisted DBS in terms of enhancing motor function and decreasing the need for antiparkinsonian medications, in comparison to traditional frame-based stereotactic techniques.Clinical trial registration: PROSPERO(CRD42024529976).
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Affiliation(s)
- Zhilong Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Lian Meng
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Xiongjie Bi
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Zhengde Xie
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Weiming Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Jinyu Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
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Fayed I, Smit RD, Vinjamuri S, Kang K, Sathe A, Sharan A, Wu C. Robot-Assisted Minimally Invasive Asleep Single-Stage Deep Brain Stimulation Surgery: Operative Technique and Systematic Review. Oper Neurosurg (Hagerstown) 2024; 26:363-371. [PMID: 37888994 DOI: 10.1227/ons.0000000000000977] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Robotic assistance has garnered increased use in neurosurgery. Recently, this has expanded to include deep brain stimulation (DBS). Several studies have reported increased accuracy and improved efficiency with robotic assistance, but these are limited to individual robotic platforms with smaller sample sizes or are broader studies on robotics not specific to DBS. Our objectives are to report our technique for robot-assisted, minimally invasive, asleep, single-stage DBS surgery and to perform a meta-analysis comparing techniques from previous studies. METHODS We performed a single-center retrospective review of DBS procedures using a floor-mounted robot with a frameless transient fiducial array registration. We compiled accuracy data (radial entry error, radial target error, and 3-dimensional target error) and efficiency data (operative time, setup time, and total procedure time). We then performed a meta-analysis of previous studies and compared these metrics. RESULTS We analyzed 315 electrodes implanted in 160 patients. The mean radial target error was 0.9 ± 0.5 mm, mean target 3-dimensional error was 1.3 ± 0.7 mm, and mean radial entry error was 1.1 ± 0.8 mm. The mean procedure time (including pulse generator placement) was 182.4 ± 47.8 minutes, and the mean setup time was 132.9 ± 32.0 minutes. The overall complication rate was 8.8% (2.5% hemorrhagic/ischemic, 2.5% infectious, and 0.6% revision). Our meta-analysis showed increased accuracy with floor-mounted over skull-mounted robotic platforms and with fiducial-based registrations over optical registrations. CONCLUSION Our technique for robot-assisted, minimally invasive, asleep, single-stage DBS surgery is safe, accurate, and efficient. Our data, combined with a meta-analysis of previous studies, demonstrate that robotic assistance can provide similar or increased accuracy and improved efficiency compared with traditional frame-based techniques. Our analysis also suggests that floor-mounted robots and fiducial-based registration methods may be more accurate.
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Affiliation(s)
- Islam Fayed
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Rupert D Smit
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Shreya Vinjamuri
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - KiChang Kang
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Anish Sathe
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Ashwini Sharan
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Chengyuan Wu
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
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Gao C, Wu X, Cheng X, Madsen KH, Chu C, Yang Z, Fan L. Individualized brain mapping for navigated neuromodulation. Chin Med J (Engl) 2024; 137:508-523. [PMID: 38269482 PMCID: PMC10932519 DOI: 10.1097/cm9.0000000000002979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Indexed: 01/26/2024] Open
Abstract
ABSTRACT The brain is a complex organ that requires precise mapping to understand its structure and function. Brain atlases provide a powerful tool for studying brain circuits, discovering biological markers for early diagnosis, and developing personalized treatments for neuropsychiatric disorders. Neuromodulation techniques, such as transcranial magnetic stimulation and deep brain stimulation, have revolutionized clinical therapies for neuropsychiatric disorders. However, the lack of fine-scale brain atlases limits the precision and effectiveness of these techniques. Advances in neuroimaging and machine learning techniques have led to the emergence of stereotactic-assisted neurosurgery and navigation systems. Still, the individual variability among patients and the diversity of brain diseases make it necessary to develop personalized solutions. The article provides an overview of recent advances in individualized brain mapping and navigated neuromodulation and discusses the methodological profiles, advantages, disadvantages, and future trends of these techniques. The article concludes by posing open questions about the future development of individualized brain mapping and navigated neuromodulation.
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Affiliation(s)
- Chaohong Gao
- Sino–Danish College, University of Chinese Academy of Sciences, Beijing 100190, China
| | - Xia Wu
- Brainnetome Center, National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Xinle Cheng
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100190, China
| | - Kristoffer Hougaard Madsen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby 2800, Denmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre 2650, Denmark
| | - Congying Chu
- Brainnetome Center, National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Zhengyi Yang
- Brainnetome Center, National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Lingzhong Fan
- Sino–Danish College, University of Chinese Academy of Sciences, Beijing 100190, China
- Brainnetome Center, National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100190, China
- CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
- School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qingdao, Shandong 266000, China
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Volk VL, Steele KA, Cinello-Smith M, Chua RV, Pollina J, Poulter G, Shafa E, Busselberg P, Fitzpatrick CK. Pedicle Screw Placement Accuracy in Robot-Assisted Spinal Fusion in a Multicenter Study. Ann Biomed Eng 2023; 51:2518-2527. [PMID: 37458895 DOI: 10.1007/s10439-023-03291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 06/17/2023] [Indexed: 10/25/2023]
Abstract
Pedicle screw fixation is a spinal fusion technique that involves the implantation of screws into vertebral pedicles to restrict movement between those vertebrae. The objective of this research is to measure pedicle screw placement accuracy using a novel automated measurement system that directly compares the implanted screw location to the planned target in all three anatomical views. Preoperative CT scans were used to plan the screw trajectories in 122 patients across four surgical centers. Postoperative scans were fused to the preoperative plan to quantify placement accuracy using an automated measurement algorithm. The mean medial-lateral and superior-inferior deviations in the pedicle region for 500 screws were 1.75 ± 1.36 mm and 1.52 ± 1.26 mm, respectively. These deviations were measured using an automated system and were statistically different from manually determined values. The uncertainty associated with the fusion of preoperative to postoperative images was also quantified to better understand the screw-to-plan accuracy results. This study uses a novel automated measurement system to quantify screw placement accuracy as it relates directly to the planned target location, instead of analyzing for breaches of the pedicle, to quantify the validity of using of a robotic-guidance system for accurate pedicle screw placement.
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Affiliation(s)
- Victoria L Volk
- Micron School of Materials Science and Engineering, Boise State University, Boise, ID, USA
- Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, MS-2085, Boise, ID, 83725-2085, USA
| | - Keegan A Steele
- Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, MS-2085, Boise, ID, 83725-2085, USA
| | - Mia Cinello-Smith
- Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, MS-2085, Boise, ID, 83725-2085, USA
| | | | - John Pollina
- Department of Neurosurgery, University of Buffalo, Buffalo, NY, USA
| | | | - Eiman Shafa
- Twin Cities Spine Center, Minneapolis, MN, USA
| | | | - Clare K Fitzpatrick
- Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, MS-2085, Boise, ID, 83725-2085, USA.
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Frameless Robot-Assisted Asleep Centromedian Thalamic Nucleus Deep Brain Stimulation Surgery in Patients with Drug-Resistant Epilepsy: Technical Description and Short-Term Clinical Results. Neurol Ther 2023; 12:977-993. [PMID: 36892782 DOI: 10.1007/s40120-023-00451-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/02/2023] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION This purpose of this work is to give a detailed description of a surgical technique for frameless robot-assisted asleep deep brain stimulation (DBS) of the centromedian thalamic nucleus (CMT) in drug-resistant epilepsy (DRE). METHODS Ten consecutively enrolled patients who underwent CMT-DBS were included in the study. The FreeSurfer "Thalamic Kernel Segmentation" module and experience target coordinates were used for locating the CMT, and quantitative susceptibility mapping (QSM) images were used to check the target. The patient's head was secured with a head clip, and electrode implantation was performed with the assistance of the neurosurgical robot Sinovation®. After opening the dura, the burr hole was continuously flushed with physiological saline to stop air from entering the skull. All procedures were performed under general anesthesia without intraoperative microelectrode recording (MER). RESULTS The mean age of the patients at surgery and onset of seizures was 22 years (range 11-41 years) and 11 years (range 1-21 years), respectively. The median duration of seizures before CMT-DBS surgery was 10 years (2-26 years). CMT was successfully segmented, and its position was verified by experience target coordinates and QSM images in all ten patients. The mean surgical time for bilateral CMT-DBS in this cohort was 165 ± 18 min. The mean pneumocephalus volume was 2 cm3. The median absolute errors in the x-, y-, and z-axes were 0.7 mm, 0.5 mm, and 0.9 mm, respectively. The median Euclidean distance (ED) and radial error (RE) was 1.3 ± 0.5 mm and 1.0 ± 0.3 mm, respectively. No significant difference was found between right- and left-sided electrodes regarding the RE nor the ED. After a mean 12-month follow-up, the average reduction in seizures was 61%, and six patients experienced a ≥ 50% reduction in seizures, including one patient who had no seizures after the operation. All patients tolerated the anesthesia operation, and no permanent or serious complications were reported. CONCLUSIONS Frameless robot-assisted asleep surgery is a precise and safe approach for placing CMT electrodes in patients with DRE, shortening the surgery time. The segmentation of the thalamic nuclei enables the precise location of the CMT, and the flow of physiological saline to seal the burr holes is a good way to reduce the influx of air. CMT-DBS is an effective method to reduce seizures.
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Hines K, Matias CM, Leibold A, Sharan A, Wu C. Accuracy and efficiency using frameless transient fiducial registration in stereoelectroencephalography and deep brain stimulation. J Neurosurg 2023; 138:299-305. [PMID: 35901701 DOI: 10.3171/2022.5.jns22804] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Stereotactic surgical methods continue to advance technologically. Frameless transient fiducial registration (FTFR) systems have been developed and avoid the need to move or position a patient in a frame after already receiving registration imaging. One such system, Neurolocate, has recently become available as a robotic attachment for the Neuromate stereotactic robot. This study is the largest in the literature to evaluate the accuracy of frameless registration using Neurolocate versus frame-based registration (FBR) methods in both deep brain stimulation (DBS) and stereoelectroencephalography (SEEG). Additionally, the authors sought to reevaluate factors affecting accuracy in both procedures. METHODS This study was a retrospective chart and imaging review of 88 consecutive procedures (involving 621 electrodes) implanting either DBS or SEEG at the authors' institution over a 5-year period from March 2015 to March 2020. Registration duration, radial target entry point, and Euclidean target implantation accuracies, as well as factors affecting accuracy, were recorded for each patient. RESULTS SEEG procedures included 38 patients and 525 implanted electrodes (294 using FBR and 231 using FTFR). DBS procedures included 50 patients and 96 implanted electrodes (65 using FBR and 31 using FTFR). Overall, FTFR registration was significantly more accurate (median 0.1 mm, IQR 0-0.4 mm) compared with FBR (median 1.3 mm, IQR 0.9-1.5 mm; p = 0.04). Likewise, FTFR had a significantly shorter duration of registration (median 84 minutes, IQR 77.3-95.3 minutes) when compared with FBR (median 110.5 minutes, IQR 107.3-138 minutes; p = 0.02). No significant differences were found when examining the radial entry point and Euclidean target implantation errors of each method. CONCLUSIONS FTFR with the Neurolocate system represents a technique that may decrease operative time while maintaining the high accuracy previously demonstrated by other stereotactic methods, despite an initial surgeon learning curve. It should be investigated in future studies to continue to improve stereotactic accuracies in neurosurgery.
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Affiliation(s)
- Kevin Hines
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Caio M. Matias
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Adam Leibold
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Ashwini Sharan
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Chengyuan Wu
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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Pivazyan G, Sandhu FA, Beaufort AR, Cunningham BW. Basis for error in stereotactic and computer-assisted surgery in neurosurgical applications: literature review. Neurosurg Rev 2022; 46:20. [PMID: 36536143 DOI: 10.1007/s10143-022-01928-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
Technological advancements in optoelectronic motion capture systems have allowed for the development of high-precision computer-assisted surgery (CAS) used in cranial and spinal surgical procedures. Errors generated sequentially throughout the chain of components of CAS may have cumulative effect on the accuracy of implant and instrumentation placement - potentially affecting patient outcomes. Navigational integrity and maintenance of fidelity of optoelectronic data is the cornerstone of CAS. Error reporting measures vary between studies. Understanding error generation, mechanisms of propagation, and how they relate to workflow can assist clinicians in error mitigation and improve accuracy during navigation in neurosurgical procedures. Diligence in planning, fiducial positioning, system registration, and intra-operative workflow have the potential to improve accuracy and decrease disparity between planned and final instrumentation and implant position. This study reviews the potential errors associated with each step in computer-assisted surgery and provides a basis for disparity in intrinsic accuracy versus achieved accuracy in the clinical operative environment.
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Affiliation(s)
- Gnel Pivazyan
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA.
| | - Faheem A Sandhu
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | | | - Bryan W Cunningham
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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Ma FZ, Liu DF, Yang AC, Zhang K, Meng FG, Zhang JG, Liu HG. Application of the robot-assisted implantation in deep brain stimulation. Front Neurorobot 2022; 16:996685. [PMID: 36531913 PMCID: PMC9755501 DOI: 10.3389/fnbot.2022.996685] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/21/2022] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION This work aims to assess the accuracy of robotic assistance guided by a videometric tracker in deep brain stimulation (DBS). METHODS We retrospectively reviewed a total of 30 DBS electrode implantations, assisted by the Remebot robotic system, with a novel frameless videometric registration workflow. Then we selected 30 PD patients who used stereotactic frame surgery to implant electrodes during the same period. For each electrode, accuracy was assessed using radial and axial error. RESULTS The average radial error of the robot-assisted electrode implantation was 1.28 ± 0.36 mm, and the average axial error was 1.20 ± 0.40 mm. No deaths or associated hemorrhages, infections or poor incision healing occurred. CONCLUSION Robot-assisted implantation guided by a videometric tracker is accurate and safe.
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Affiliation(s)
- Fang-Zhou Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - De-Feng Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - An-Chao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Fan-Gang Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Huan-Guang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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Giridharan N, Katlowitz KA, Anand A, Gadot R, Najera RA, Shofty B, Snyder R, Larrinaga C, Prablek M, Karas PJ, Viswanathan A, Sheth SA. Robot-Assisted Deep Brain Stimulation: High Accuracy and Streamlined Workflow. Oper Neurosurg (Hagerstown) 2022; 23:254-260. [PMID: 35972090 DOI: 10.1227/ons.0000000000000298] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/03/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A number of stereotactic platforms are available for performing deep brain stimulation (DBS) lead implantation. Robot-assisted stereotaxy has emerged more recently demonstrating comparable accuracy and shorter operating room times compared with conventional frame-based systems. OBJECTIVE To compare the accuracy of our streamlined robotic DBS workflow with data in the literature from frame-based and frameless systems. METHODS We retrospectively reviewed 126 consecutive DBS lead placement procedures using a robotic stereotactic platform. Indications included Parkinson disease (n = 94), essential tremor (n = 21), obsessive compulsive disorder (n = 7), and dystonia (n = 4). Procedures were performed using a stereotactic frame for fixation and the frame pins as skull fiducials for robot registration. We used intraoperative fluoroscopic computed tomography for registration and postplacement verification. RESULTS The mean radial error for the target point was 1.06 mm (SD: 0.55 mm, range 0.04-2.80 mm) on intraoperative fluoroscopic computed tomography. The mean operative time for an asleep, bilateral implant without implantable pulse generator placement was 238 minutes (SD: 52 minutes), and skin-to-skin procedure time was 116 minutes (SD: 42 minutes). CONCLUSION We describe a streamlined workflow for DBS lead placement using robot-assisted stereotaxy with a comparable accuracy profile. Obviating the need for checking and switching coordinates, as is standard for frame-based DBS, also reduces the chance for human error and facilitates training.
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Affiliation(s)
- Nisha Giridharan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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Fenoy AJ, Conner CR. Frameless Robot-Assisted vs Frame-Based Awake Deep Brain Stimulation Surgery: An Evaluation of Technique and New Challenges. Oper Neurosurg (Hagerstown) 2022; 22:171-178. [PMID: 34989699 DOI: 10.1227/ons.0000000000000059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Methodological approaches to deep brain stimulation (DBS) continue to evolve from awake frame-based to asleep frameless procedures with robotic assistance, primarily directed to optimize operative efficiency, lead accuracy, and patient comfort. Comparison between the 2 is scarce. OBJECTIVE To analyze the impacts of methodological differences on operative efficiency and stereotactic accuracy using a frame compared with a frameless robotic platform while maintaining the awake state and use of multiple microelectrode recording (MER) trajectories. METHODS Thirty-four consecutive patients who underwent bilateral awake frameless robot-assisted DBS were compared with a previous cohort of 30 patients who underwent frame-based surgery. Patient demographics, operative times, and MER data were collected for both cohorts. Two-dimensional radial errors of lead placements were calculated. RESULTS Preoperative setup, surgical, and total operating room times were all significantly greater for the robot-assisted cohort (P < .001). The need for computed tomography imaging when referencing the robotic fiducials led to increased setup duration because of patient transport, unnecessary for the frame-based cohort. Multiple simultaneous MER trajectories increased surgical time (mean 26 min) for the robot-assisted cohort only. The mean radial errors in the robot-assisted and frame cohorts were 0.98 ± 0.66 and 0.74 ± 0.49 mm (P = .03), respectively. CONCLUSION The use of a truly frameless robotic platform such as the Mazor Renaissance (Mazor Robotics Ltd) presented challenges when implementing techniques used during awake frame-based surgery. Maintaining good accuracy, intraoperative reference imaging, and limited MER trajectories will help integrate frameless robot assistance into the awake DBS surgical workflow.
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Affiliation(s)
- Albert J Fenoy
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, Texas, USA
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Bibi Farouk ZI, Jiang S, Yang Z, Umar A. A Brief Insight on Magnetic Resonance Conditional Neurosurgery Robots. Ann Biomed Eng 2022; 50:138-156. [PMID: 34993701 DOI: 10.1007/s10439-021-02891-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/08/2021] [Indexed: 12/19/2022]
Abstract
The brain is a delicate organ in the human body that requires extreme care. Brain-related diseases are unavoidable. Perse, neurosurgery is a complicated procedure that demands high precision and accuracy. Developing a surgical robot is a complex task. To date, there are only a handful of neurosurgery robots in the market that distinctly undergo clinical procedures. These robots have exorbitant cost that hinders the utmost care progress in the area as they are unaffordable. This paper looked at the historical perspective and presented insight literature of the magnetic resonance conditional stereotactic neurosurgery robots that find their ways in clinics, abandoning research projects and promising research yet to undergo clinical use. In addition, the study also gives a thorough insight into the advantage of magnetic resonance imaging modalities and magnetic resonance conditional robots and the future challenges in automation use. Image compatibility test data and accuracy results are also examined because they guarantee that these systems work correctly in particular imaging settings. The primary differences between these systems include actuation and control technologies, construction materials, and the degree of freedom. Thus, one system has an advantage over the other.
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Affiliation(s)
- Z I Bibi Farouk
- Mechanical Engineering Department, Tianjin University, No. 135, Yaguan Road, Haihe Education Park, Jinnan District, Tianjin, 300354, China
| | - Shan Jiang
- Mechanical Engineering Department, Tianjin University, No. 135, Yaguan Road, Haihe Education Park, Jinnan District, Tianjin, 300354, China.
| | - Zhiyong Yang
- Mechanical Engineering Department, Tianjin University, No. 135, Yaguan Road, Haihe Education Park, Jinnan District, Tianjin, 300354, China
| | - Abubakar Umar
- Mechanical Engineering Department, Hebei University of Technology, Tianjin, China
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Hart M, Posa M, Buttery P, Morris R. Increased variance in second electrode accuracy during deep brain stimulation and its relationship to pneumocephalus, brain shift, and clinical outcomes: A retrospective cohort study. BRAIN AND SPINE 2022; 2:100893. [PMID: 36248097 PMCID: PMC9560590 DOI: 10.1016/j.bas.2022.100893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
Abstract
Overall electrode accuracy was 0.22+/-0.4 mm with only 3 (4%) electrodes out with 2 mm from the intended target. Accuracy was significantly worse in the GPi versus the STN and on the second side implanted. Inaccuracy occurred in the X (lateral) plane but was not related to pneumocephalus or brain shift.
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Affiliation(s)
- M.G. Hart
- St George’s University of London, Cranmer Terrace, London, SW17 0RE, UK
- Corresponding author.
| | - M. Posa
- Department of Neurosurgery, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
| | - P.C. Buttery
- Department of Neurology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
| | - R.C. Morris
- Department of Neurosurgery, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
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14
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Liang AS, Ginalis EE, Jani R, Hargreaves EL, Danish SF. Frameless Robotic-Assisted Deep Brain Stimulation With the Mazor Renaissance System. Oper Neurosurg (Hagerstown) 2021; 22:158-164. [DOI: 10.1227/ons.0000000000000050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022] Open
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Abstract
PURPOSE OF REVIEW Deep brain stimulation (DBS) is a rapidly expanding surgical modality for the treatment of patients with movement disorders. Its ability to be adjusted, titrated, and optimized over time has given it a significant advantage over traditional more invasive surgical procedures. Therefore, the success and popularity of this procedure have led to the discovery of new indications and therapeutic targets as well as advances in surgical techniques. The aim of this review is to highlight the important updates in DBS surgery and to exam the anesthesiologist's role in providing optimal clinical management. RECENT FINDINGS New therapeutic indications have a significant implication on perioperative anesthesia management. In addition, new technologies like frameless stereotaxy and intraoperative magnetic resonance imaging to guide electrode placement have altered the need for intraoperative neurophysiological monitoring and hence increased the use of general anesthesia. With an expanding number of patients undergoing DBS implantation, patients with preexisting DBS increasingly require anesthesia for unrelated surgery and the anesthesiologist must be aware of the considerations for perioperative management of these devices and potential complications. SUMMARY DBS will continue to grow and evolve requiring adaptation and modification to the anesthetic management of these patients.
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Affiliation(s)
- Michael Dinsmore
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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16
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Liu DF, Liu HG, Zhang K, Meng FG, Yang AC, Zhang JG. The Clinical Application of Robot-Assisted Ventriculoperitoneal Shunting in the Treatment of Hydrocephalus. Front Neurosci 2021; 15:685142. [PMID: 34421517 PMCID: PMC8376146 DOI: 10.3389/fnins.2021.685142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background This work aims to assess the effectiveness and safety of robotic assistance in ventriculoperitoneal shunting and to compare the results with data from traditional surgery. Methods We retrospectively analyzed 60 patients who had undergone ventriculoperitoneal shunting, of which shunts were implanted using a robot in 20 patients and using traditional surgical methods in the other 40 patients. Data related to surgery were compared between the two groups, and the accuracy of the drainage tube in the robot-assisted group was assessed. Results In the robot-assisted surgery group, the operation duration was 29.75 ± 6.38 min, intraoperative blood loss was 10.0 ± 3.98 ml, the success rate of a single puncture was 100%, and the bone hole diameter was 4.0 ± 0.3 mm. On the other hand, the operation duration was 48.63 ± 6.60 min, intraoperative blood loss was 22.25 ± 4.52 ml, the success rate of a single puncture was 77.5%, and the bone hole diameter was 11.0 ± 0.2 mm in the traditional surgery group. The above are statistically different between the two groups (P < 0.05). Only one case of surgery-related complications occurred in the robot-assisted group, while 13 cases occurred in the traditional surgery group. There was no significant difference in the hospitalization time. In the robot-assisted surgery group, the average radial error was 2.4 ± 1.5 mm and the average axial error was 1.9 ± 2.1 mm. Conclusion In summary, robot-assisted implantation is accurate, simple to operate, and practical; the duration of surgery is short; trauma to the patient is reduced; and fewer postoperative complications related to surgery are reported.
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Affiliation(s)
- De-Feng Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huan-Guang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Fan-Gang Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - An-Chao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
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17
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Ball T, González-Martínez J, Zemmar A, Sweid A, Chandra S, VanSickle D, Neimat JS, Jabbour P, Wu C. Robotic Applications in Cranial Neurosurgery: Current and Future. Oper Neurosurg (Hagerstown) 2021; 21:371-379. [PMID: 34192764 DOI: 10.1093/ons/opab217] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/16/2021] [Indexed: 12/19/2022] Open
Abstract
Robotics applied to cranial surgery is a fast-moving and fascinating field, which is transforming the practice of neurosurgery. With exponential increases in computing power, improvements in connectivity, artificial intelligence, and enhanced precision of accessing target structures, robots are likely to be incorporated into more areas of neurosurgery in the future-making procedures safer and more efficient. Overall, improved efficiency can offset upfront costs and potentially prove cost-effective. In this narrative review, we aim to translate a broad clinical experience into practical information for the incorporation of robotics into neurosurgical practice. We begin with procedures where robotics take the role of a stereotactic frame and guide instruments along a linear trajectory. Next, we discuss robotics in endoscopic surgery, where the robot functions similar to a surgical assistant by holding the endoscope and providing retraction, supplemental lighting, and correlation of the surgical field with navigation. Then, we look at early experience with endovascular robots, where robots carry out tasks of the primary surgeon while the surgeon directs these movements remotely. We briefly discuss a novel microsurgical robot that can perform many of the critical operative steps (with potential for fine motor augmentation) remotely. Finally, we highlight 2 innovative technologies that allow instruments to take nonlinear, predetermined paths to an intracranial destination and allow magnetic control of instruments for real-time adjustment of trajectories. We believe that robots will play an increasingly important role in the future of neurosurgery and aim to cover some of the aspects that this field holds for neurosurgical innovation.
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Affiliation(s)
- Tyler Ball
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | | | - Ajmal Zemmar
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.,Department of Neurosurgery, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Henan University People's Hospital, Henan University School of Medicine, Zhengzhou, China
| | - Ahmad Sweid
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Science, New Delhi, India
| | | | - Joseph S Neimat
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Chengyuan Wu
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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18
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Furlanetti L, Ellenbogen J, Gimeno H, Ainaga L, Narbad V, Hasegawa H, Lin JP, Ashkan K, Selway R. Targeting accuracy of robot-assisted deep brain stimulation surgery in childhood-onset dystonia: a single-center prospective cohort analysis of 45 consecutive cases. J Neurosurg Pediatr 2021; 27:677-687. [PMID: 33862592 DOI: 10.3171/2020.10.peds20633] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an established treatment for pediatric dystonia. The accuracy of electrode implantation is multifactorial and remains a challenge in this age group, mainly due to smaller anatomical targets in very young patients compared to adults, and also due to anatomical abnormalities frequently associated with some etiologies of dystonia. Data on the accuracy of robot-assisted DBS surgery in children are limited. The aim of the current paper was to assess the accuracy of robot-assisted implantation of DBS leads in a series of patients with childhood-onset dystonia. METHODS Forty-five children with dystonia undergoing implantation of DBS leads under general anesthesia between 2017 and 2019 were included. Robot-assisted stereotactic implantation of the DBS leads was performed. The final position of the electrodes was verified with an intraoperative 3D scanner (O-arm). Coordinates of the planned electrode target and actual electrode position were obtained and compared, looking at the radial error, depth error, absolute error, and directional error, as well as the euclidean distance. Functional assessment data prospectively collected by a multidisciplinary pediatric complex motor disorders team were analyzed with regard to motor skills, individualized goal achievement, and patients' and caregivers' expectations. RESULTS A total of 90 DBS electrodes were implanted and 48.5% of the patients were female. The mean age was 11.0 ± 0.6 years (range 3-18 years). All patients received bilateral DBS electrodes into the globus pallidus internus. The median absolute errors in x-, y-, and z-axes were 0.85 mm (range 0.00-3.25 mm), 0.75 mm (range 0.05-2.45 mm), and 0.75 mm (range 0.00-3.50 mm), respectively. The median euclidean distance from the target to the actual electrode position was 1.69 ± 0.92 mm, and the median radial error was 1.21 ± 0.79. The robot-assisted technique was easily integrated into the authors' surgical practice, improving accuracy and efficiency, and reducing surgical time significantly along the learning curve. No major perioperative complications occurred. CONCLUSIONS Robot-assisted stereotactic implantation of DBS electrodes in the pediatric age group is a safe and accurate surgical method. Greater accuracy was present in this cohort in comparison to previous studies in which conventional stereotactic frame-based techniques were used. Robotic DBS surgery and neuroradiological advances may result in further improvement in surgical targeting and, consequently, in better clinical outcome in the pediatric population.
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Affiliation(s)
- Luciano Furlanetti
- 1Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London
- 4King's Health Partners Academic Health Sciences Centre, London, United Kingdom
| | | | - Hortensia Gimeno
- 2Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London
- 4King's Health Partners Academic Health Sciences Centre, London, United Kingdom
| | - Laura Ainaga
- 2Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London
- 4King's Health Partners Academic Health Sciences Centre, London, United Kingdom
| | - Vijay Narbad
- 1Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London
| | - Harutomo Hasegawa
- 1Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London
- 4King's Health Partners Academic Health Sciences Centre, London, United Kingdom
| | - Jean-Pierre Lin
- 2Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London
- 4King's Health Partners Academic Health Sciences Centre, London, United Kingdom
| | - Keyoumars Ashkan
- 1Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London
- 4King's Health Partners Academic Health Sciences Centre, London, United Kingdom
| | - Richard Selway
- 1Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London
- 4King's Health Partners Academic Health Sciences Centre, London, United Kingdom
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Lin L, Xu C, Shi Y, Zhou C, Zhu M, Chai G, Xie L. Preliminary clinical experience of robot-assisted surgery in treatment with genioplasty. Sci Rep 2021; 11:6365. [PMID: 33739026 PMCID: PMC7973719 DOI: 10.1038/s41598-021-85889-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/08/2021] [Indexed: 12/19/2022] Open
Abstract
Genioplasty is the main way to treat diseases such as chin asymmetry, dysplasia and overdevelopment, which involve the three-dimensional direction abnormalities of the chin. Since this kind of surgery mainly uses intraoral incisions, the narrow surgical field of intraoral incisions and the surrounding important neurovascular tissues make it easy for complications, to occur during the osteotomy process, which results in greater surgical risks. The first craniofacial-plastic surgical robot (CPSR-I) system is developed to complete the precise positioning and improve the surgeon's force perception ability. The Kalman filtering method is adopted to reduce the interference of sensor signal noise. An adaptive fuzzy control system, which has strong robustness and adaptability to the environment, is designed to improve the stability of robot-assisted surgical operations. To solve the problem of the depth perception, we propose an automatic bone drilling control strategy that combines position and force conditions to ensure that the robot can automatically stop when the bone is penetrated. On the basis of model surgery and animal experiments, preliminary experiments were carried out clinically. Based on the early results of 6 patients, the robot-assisted approach appears to be a safe and effective strategy for genioplasty.
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Affiliation(s)
- Li Lin
- Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Xuhui Campus, 1954 Hua Shan Rd, Shanghai, 200030, China
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Cheng Xu
- Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Xuhui Campus, 1954 Hua Shan Rd, Shanghai, 200030, China
| | - Yunyong Shi
- Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Xuhui Campus, 1954 Hua Shan Rd, Shanghai, 200030, China
| | - Chaozheng Zhou
- Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Xuhui Campus, 1954 Hua Shan Rd, Shanghai, 200030, China
| | - Ming Zhu
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Gang Chai
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd, Shanghai, 200011, China.
- The College of Medical Instrument, Shanghai University of Medicine & Health Sciences, No. 257, Zhouzhu Highway, Pudong Campus, Shanghai, 200120, China.
- Department of Plastic and Reconstructive Surgery, Maternal and Child Health Care Hospital of Hainan Province, Haikou, 570206, China.
| | - Le Xie
- Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Xuhui Campus, 1954 Hua Shan Rd, Shanghai, 200030, China.
- Institute of Medical Robotics, Shanghai Jiao Tong University, Minhang Campus, 800 Dong Chuan Rd, Shanghai, 200240, China.
- National Digital Manufacturing Technology Center, Shanghai Jiao Tong University, Xuhui Campus, 1954 Hua Shan Rd, Shanghai, 200030, China.
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20
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Wu W, Xu C, Pan C, Huang Z, Zhou J, Huang P. Effect of vibration frequency on frictional resistance of brain tissue during vibration-assisted needle insertion. Med Eng Phys 2020; 86:35-40. [PMID: 33261731 DOI: 10.1016/j.medengphy.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 09/11/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
Deep brain stimulation (DBS) is an effective treatment for Parkinson's disease. The cannula insertion process plays an important role in DBS. The friction force during needle insertion influences the precision of the insertion and the degree of damage to the brain tissue. This paper proposes a method of longitudinal vibration assisted insertion to reduce the friction during insertion and improve the effects of the insertion. Cannulas were inserted into twenty eight pig brains at multiple frequencies and fixed amplitudes, and the resulting friction force was measured. On this basis, the LuGre model was used to analyze the friction force trend under vibration-assisted conditions. The frictional forces of vibration-assisted insertion with frequencies ranging from 200-1200 Hz and an amplitude of 1 μm were measured. The results show that the friction between the needle shaft and the tissue is smaller with vibration than without vibration. In this experiment, the friction is reduced by up to 24.43%. The friction force trend of vibration-assisted insertion conforms to the simulation results of the LuGre model.
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Affiliation(s)
- Wenhao Wu
- School of Mechanical Engineering, Shandong University, Jinan 250061, China; Key Laboratory of High Efficiency and Clean Mechanical Manufacture (Shandong University), Ministry of Education, Jinan 250061, China
| | - Changfeng Xu
- School of Mechanical Engineering, Shandong University, Jinan 250061, China; Key Laboratory of High Efficiency and Clean Mechanical Manufacture (Shandong University), Ministry of Education, Jinan 250061, China
| | - Chunyang Pan
- School of Mechanical Engineering, Shandong University, Jinan 250061, China; Key Laboratory of High Efficiency and Clean Mechanical Manufacture (Shandong University), Ministry of Education, Jinan 250061, China
| | - Zhixiang Huang
- School of Mechanical Engineering, Shandong University, Jinan 250061, China; Key Laboratory of High Efficiency and Clean Mechanical Manufacture (Shandong University), Ministry of Education, Jinan 250061, China
| | - Jun Zhou
- School of Mechanical Engineering, Shandong University, Jinan 250061, China; Key Laboratory of High Efficiency and Clean Mechanical Manufacture (Shandong University), Ministry of Education, Jinan 250061, China.
| | - Panling Huang
- School of Mechanical Engineering, Shandong University, Jinan 250061, China; Key Laboratory of High Efficiency and Clean Mechanical Manufacture (Shandong University), Ministry of Education, Jinan 250061, China
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21
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Furlanetti L, Hasegawa H, Oviedova A, Raslan A, Samuel M, Selway R, Ashkan K. O-Arm Stereotactic Imaging in Deep Brain Stimulation Surgery Workflow: A Utility and Cost-Effectiveness Analysis. Stereotact Funct Neurosurg 2020; 99:93-106. [PMID: 33260175 DOI: 10.1159/000510344] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/21/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Deep brain stimulation (DBS) surgery is an established treatment for movement disorders. Advances in neuroimaging techniques have resulted in improved targeting accuracy that may improve clinical outcomes. This study aimed to evaluate the safety and feasibility of using the Medtronic O-arm device for the acquisition of intraoperative stereotactic imaging, targeting, and localization of DBS electrodes compared with standard stereotactic MRI or computed tomography (CT). METHODS Patients were recruited prospectively into the study. Routine frame-based stereotactic DBS surgery was performed. Intraoperative imaging was used to facilitate and verify the accurate placement of the intracranial electrodes. The acquisition of coordinates and verification of the position of the electrodes using the O-arm were evaluated and compared with conventional stereotactic MRI or CT. Additionally, a systematic review of the literature on the use of intraoperative imaging in DBS surgery was performed. RESULTS Eighty patients were included. The indications for DBS surgery were dystonia, Parkinson's disease, essential tremor, and epilepsy. The globus pallidus internus was the most commonly targeted region (43.7%), followed by the subthalamic nucleus (35%). Stereotactic O-arm imaging reduced the overall surgical time by 68 min, reduced the length of time of acquisition of stereotactic images by 77%, reduced patient exposure to ionizing radiation by 24.2%, significantly reduced operating room (OR) costs per procedure by 31%, and increased the OR and neuroradiology suite availability. CONCLUSIONS The use of the O-arm in DBS surgery workflow significantly reduced the duration of image acquisition, the exposure to ionizing radiation, and costs when compared with standard stereotactic MRI or CT, without reducing accuracy.
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Affiliation(s)
- Luciano Furlanetti
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Harutomo Hasegawa
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Anna Oviedova
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ahmed Raslan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Michael Samuel
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Selway
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
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22
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Butt AH, Rovini E, Fujita H, Maremmani C, Cavallo F. Data-Driven Models for Objective Grading Improvement of Parkinson's Disease. Ann Biomed Eng 2020; 48:2976-2987. [PMID: 33006005 PMCID: PMC7723941 DOI: 10.1007/s10439-020-02628-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/18/2020] [Indexed: 12/20/2022]
Abstract
Parkinson's disease (PD) is a progressive disorder of the central nervous system that causes motor dysfunctions in affected patients. Objective assessment of symptoms can support neurologists in fine evaluations, improving patients' quality of care. Herein, this study aimed to develop data-driven models based on regression algorithms to investigate the potential of kinematic features to predict PD severity levels. Sixty-four patients with PD (PwPD) and 50 healthy subjects of control (HC) were asked to perform 13 motor tasks from the MDS-UPDRS III while wearing wearable inertial sensors. Simultaneously, the clinician provided the evaluation of the tasks based on the MDS-UPDRS scores. One hundred-ninety kinematic features were extracted from the inertial motor data. Data processing and statistical analysis identified a set of parameters able to distinguish between HC and PwPD. Then, multiple feature selection methods allowed selecting the best subset of parameters for obtaining the greatest accuracy when used as input for several predicting regression algorithms. The maximum correlation coefficient, equal to 0.814, was obtained with the adaptive neuro-fuzzy inference system (ANFIS). Therefore, this predictive model could be useful as a decision support system for a reliable objective assessment of PD severity levels based on motion performance, improving patients monitoring over time.
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Affiliation(s)
- Abdul Haleem Butt
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio, 34, 56025, Pontedera, Italy.,Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy.,The Creative Technology Department, Faculty of Computing and Artificial Intelligence, Air University Islamabad Pakistan, Service Road E-9/E-8, Islamabad, Pakistan
| | - Erika Rovini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio, 34, 56025, Pontedera, Italy.,Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Hamido Fujita
- Intelligent Software Systems Lab, Iwate Prefectural University, 152-52, Sugo, Takizawa, Iwate, Japan
| | - Carlo Maremmani
- U.O. Neurologia, Ospedale delle Apuane (AUSL Toscana Nord Ovest), Viale Mattei 21, 54100, Massa, Italy
| | - Filippo Cavallo
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio, 34, 56025, Pontedera, Italy. .,Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy. .,The Department of Industrial Engineering, University of Florence, Via Santa Marta 3, 50139, Florence, Italy.
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23
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Wang R, Han Y, Luo MZ, Wang NK, Sun WW, Wang SC, Zhang HD, Lu LJ. Accuracy study of a binocular-stereo-vision-based navigation robot for minimally invasive interventional procedures. World J Clin Cases 2020; 8:3440-3449. [PMID: 32913850 PMCID: PMC7457116 DOI: 10.12998/wjcc.v8.i16.3440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/07/2020] [Accepted: 07/18/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Medical robot is a promising surgical tool, but no specific one has been designed for interventional treatment of chronic pain. We developed a computed tomography-image based navigation robot using a new registration method with binocular vision. This kind of robot is appropriate for minimal invasive interventional procedures and easy to operate. The feasibility, accuracy and stability of this new robot need to be tested.
AIM To assess quantitatively the feasibility, accuracy and stability of the binocular-stereo-vision-based navigation robot for minimally invasive interventional procedures.
METHODS A box model was designed for assessing the accuracy for targets at different distances. Nine (three sets) lead spheres were embedded in the model as puncture goals. The entry-to-target distances were set 50 mm (short-distance), 100 mm (medium-distance) and 150 mm (long-distance). Puncture procedure was repeated three times for each goal. The Euclidian error of each puncture was calculated and statistically analyzed. Three head phantoms were used to explore the clinical feasibility and stability. Three independent operators conducted foramen ovale placement on head phantoms (both sides) by freehand or under the guidance of robot (18 punctures with each method). The operation time, adjustment time and one-time success rate were recorded, and the two guidance methods were compared.
RESULTS On the box model, the mean puncture errors of navigation robot were 1.7 ± 0.9 mm for the short-distance target, 2.4 ± 1.0 mm for the moderate target and 4.4 ± 1.4 mm for the long-distance target. On the head phantom, no obvious differences in operation time and adjustment time were found among the three performers (P > 0.05). The median adjustment time was significantly less under the guidance of the robot than under free hand. The one-time success rate was significantly higher with the robot (P < 0.05). There was no obvious difference in operation time between the two methods (P > 0.05).
CONCLUSION In the laboratory environment, accuracy of binocular-stereo-vision-based navigation robot is acceptable for target at 100 mm depth or less. Compared with freehand, foramen ovale placement accuracy can be improved with robot guidance.
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Affiliation(s)
- Ran Wang
- Department of Pain Management, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Ying Han
- Department of Pain Management, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Min-Zhou Luo
- Institute of Intelligent Manufacturing Technology, Jiangsu Industrial Technology Research Institute, Nanjing 210000, Jiangsu Province, China
| | - Nai-Kun Wang
- Department of Pain Management, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Wei-Wei Sun
- Department of Pain Management, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Shi-Chong Wang
- Department of Pain Management, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Hua-Dong Zhang
- Institute of Intelligent Manufacturing Technology, Jiangsu Industrial Technology Research Institute, Nanjing 210000, Jiangsu Province, China
| | - Li-Juan Lu
- Department of Pain Management, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
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Villanueva-Naquid I, Soubervielle-Montalvo C, Aguilar-Ponce RM, Tovar-Arriaga S, Cuevas-Tello JC, Puente-Montejano CA, Mejia-Carlos M, Torres-Corzo JG. Risk assessment methodology for trajectory planning in keyhole neurosurgery using genetic algorithms. Int J Med Robot 2019; 16:e2060. [PMID: 31760679 DOI: 10.1002/rcs.2060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Preoperative assessment to find the safest trajectory in keyhole neurosurgery can reduce post operative complications. METHODS We introduced a novel preoperative risk assessment semiautomated methodology based on the sum of N maximum risk values using a generic genetic algorithm for the safest trajectory search. RESULTS A set of candidates trajectories were found for two surgical procedures. The trajectories search is done using a risk map considering the proximity of voxels within risk structures in multiple points and a genetic algorithm to avoid an exhaustive search. The trajectories were validated by a group of neurosurgeons. CONCLUSIONS The trajectories obtained with the proposal method were shorter in 5% and have greater distance from the voxels within the blood vessels in 4.7%. The use of genetic algorithm (GA) speeds up the search for the safest trajectory, decreasing in 99.9% the time required for an exhaustive search.
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Affiliation(s)
| | | | - Ruth M Aguilar-Ponce
- Sciences Faculty, Autonomous University of San Luis Potosí, San Luis Potosí, México
| | - Saúl Tovar-Arriaga
- Engineering Faculty, Autonomous University of Querétaro, Querétaro, México
| | - Juan C Cuevas-Tello
- Engineering Faculty, Autonomous University of San Luis Potosí, San Luis Potosí, México
| | | | - Marcela Mejia-Carlos
- Optical Communication Research Institute, Autonomous University of San Luis Potosí, San Luis Potosí, México
| | - Jaime G Torres-Corzo
- Department of Neurosurgery, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, México
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