Robotic System for MRI-Guided Stereotactic Neurosurgery

Abstract

Stereotaxy is a neurosurgical technique that can take several hours to reach a specific target, typically utilizing a mechanical frame and guided by preoperative imaging. An error in any one of the numerous steps or deviations of the target anatomy from the preoperative plan such as brain shift (up to 20 mm), may affect the targeting accuracy and thus the treatment effectiveness. Moreover, because the procedure is typically performed through a small burr hole opening in the skull that prevents tissue visualization, the intervention is basically “blind” for the operator with limited means of intraoperative confirmation that may result in reduced accuracy and safety. The presented system is intended to address the clinical needs for enhanced efficiency, accuracy, and safety of image-guided stereotactic neurosurgery for Deep Brain Stimulation (DBS) lead placement. The work describes a magnetic resonance imaging (MRI)-guided, robotically actuated stereotactic neural intervention system for deep brain stimulation procedure, which offers the potential of reducing procedure duration while improving targeting accuracy and enhancing safety. This is achieved through simultaneous robotic manipulation of the instrument and interactively updated in situ MRI guidance that enables visualization of the anatomy and interventional instrument. During simultaneous actuation and imaging, the system has demonstrated less than 15% signal-to-noise ratio (SNR) variation and less than 0.20% geometric distortion artifact without affecting the imaging usability to visualize and guide the procedure. Optical tracking and MRI phantom experiments streamline the clinical workflow of the prototype system, corroborating targeting accuracy with 3-axis root mean square error 1.38 ± 0.45 mm in tip position and 2.03 ± 0.58° in insertion angle.

Review on Factors Affecting Targeting Accuracy of Deep Brain Stimulation Electrode Implantation between 2001 and 2015

“…Advanced image fusion algorithms are needed to minimize this error [56,57,59,60]. Another effective strategy is to develop MRI-compatible devices or high-resolution MRI systems, which has become a trend in recent years [12,13,15,25,35,41,54,61,62]. …”

Magnetic resonance–guided interstitial high-intensity focused ultrasound for brain tumor ablation

“…2). 16 Three degrees of freedom (DOF) enable placement of the tip at the burr hole skull entry point, with the probe at the intended orientation. An additional 2 DOF provide for insertion and rotation of the instrument.…”

Robotic-assisted real-time MRI-guided TAVR: from system deployment to in vivo experiment in swine model

“…Magnetic resonance (MR)-compatible robotic systems have been developed for various medical interventions, from prostate brachytherapy to neurosurgery [12][13][14][15][16][17][18][19][20]. Among all MR-compatible systems, two general-purpose devices have been designed for use with a standard closed-bore scanner [21,22].…”